Heart rate as a predictor of cardiovascular risk

Abstract

Background: Heart rate (HR) is a predictor of cardiovascular, cerebrovascular and all-cause mortality in the general population, as well as in patients with cardio-and cerebrovascular diseases. We aimed to summarize current knowledge regarding the influence of HR on cardio-and cerebrovascular morbidity and mortality. Materials and methods: PubMed, MEDLINE, Ovid and EMBASE databases were searched for large follow-up studies or meta-analysis published between January 1990 and September 2017 in the English language using the following keyword "heart rate," "resting heart rate," "mortality," "outcome," "hypertension," "heart failure," "ischaemic heart disease," "coronary heart disease" and "stroke." Results:The relationship between increased HR and cardio-and cerebrovascular morbidity and mortality has been reported in a large number of studies, and the results regarding this association are concurrent. This connection is generally stronger in men than in women. The increase in HR usually occurs in parallel with elevation of blood pressure and metabolic disturbances (insulin resistance, dyslipidaemia). However, even after adjustment for the most important cardiovascular risk factors, HR remained an independent predictor of adverse events in global population or in patients with cardio-and cerebrovascular diseases. Conclusion: HR has an important negative effect on cardio-and cerebrovascular morbidity and mortality. Future longitudinal investigations should clarify HR significance and optimal HR reduction for primary and secondary prevention in cardio-and cerebrovascular events.

Circadian‐timed quick‐release bromocriptine lowers elevated resting heart rate in patients with type 2 diabetes mellitus

“…It is important to appreciate in general and relative to the present investigation in particular that a large body of evidence indicates that while tachycardia is usually defined as heart rate ≥100 BPM, RHR thresholds substantially lower than this traditional tachycardia criterion are also associated with significant increased cardiovascular risks . Accumulating evidence from a multitude of large longitudinal epidemiological studies and clinical trials indicate that chronically elevated RHR over a threshold of approximately the >70‐80 BPM range is significantly associated with and is a predictor of increased cardiometabolic risk (insulin resistance, metabolic syndrome, type 2 diabetes and CVD) as well as both cardiovascular and all‐cause mortality and such associations have been reported in general healthy populations as well as in those with hypertension, coronary artery disease or heart failure . RHR ≥70 BPM has therefore been used as the cut‐off for defining elevated RHR in previous clinical studies having identified increased CVD risk above this threshold .…”

“…While the autonomic imbalance of elevated SNS and depressed PSNS activities to the heart each can contribute to elevated RHR, available evidence suggests that the elevated RHR association with insulin resistance syndrome is most closely coupled to overactive SNS tone that involves several metabolic tissues in addition to the heart . Both elevated RHR and elevated SNS tone are associated with and predict the future onset of CVD, insulin resistance, metabolic syndrome and type 2 diabetes. The association of elevated RHR with development of type 2 diabetes has been mainly attributed to increased insulin resistance secondary to elevated SNS activity, although elevated RHR has also been reported to be a predictor of beta cell dysfunction and consequent impaired glucose regulation independent of the level of insulin sensitivity …”

“…Chronic SNS overactivity is an important pathophysiological phenomenon that potentiates hypertension, vasoconstriction and vascular insulin resistance, vascular oxidative stress, endothelial dysfunction, myocardial oxidative and nitrative stress and apoptosis, and renal renin‐angiotensin system overactivation, as well as metabolic changes such as increased adipose inflammation and lipolysis (inducing hyperaemia, a potent stimulus for central activation of SNS tone), increased hepatic oxidative stress, inflammation, lipotoxicity, glucose output, insulin resistance, ectopic fat deposition and muscle insulin resistance . Collectively, these pathophysiologies underlie development of vascular stiffness and arteriosclerosis, atherosclerosis and atherosclerosis progression, cardiac remodelling, occurrence of myocardial ischaemia and arrhythmias, reduced left ventricular function, kidney dysfunction, hypertension and metabolic derangements of obesity, dyslipidemia, metabolic syndrome and type 2 diabetes, occurrences often associated with elevated RHR …”

“…While clinically RHR between 60 and 100 beats per minute (BPM) is considered the “normal” range for RHR and RHR ≥100 is used as the criteria for defining tachycardia, a large body of evidence from epidemiological and clinical studies suggests that increasing RHR within the “normal” range is associated with increased cardiometabolic risk, particularly above 70‐80 beats per minute (BPM). Such elevated RHR has been associated with insulin resistance, altered beta cell function, impaired glucose regulation and increased risk of developing type 2 diabetes mellitus as well as increased cardiovascular disease (CVD) risk and mortality …”

Automated high-throughput heart rate measurement in medaka and zebrafish embryos under physiological conditions

“…Quantification of heartbeats is an important readout to study physiology and disease states of the heart. The resting heart rate (beats per minute, bpm) is a strong predictive risk factor of overall mortality 1 and associated with a growing catalogue of genetic variants and environmental-sensitive alleles 2,3 . However, geneticists are facing an enormous challenge to establish causality for associated candidate variants.…”