Resting, night-time, and 24 h heart rate as markers of cardiovascular risk in middle-aged and elderly men and women with no apparent heart disease

Johansen, Christine D.; Olsen, Rasmus Huan; Pedersen, Lene; Kumarathurai, Preman; Mouridsen, Mette Rauhe; Binici, Zeynep; Intzilakis, Theodoros; Køber, Lars; Sajadieh, Ahmad

doi:10.1093/eurheartj/ehs449

Cited by 131 publications

(108 citation statements)

References 25 publications

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“…A recent study in middle-aged and elderly persons without manifest heart disease showed that each increment of 5 beats/min resulted in an 11% higher risk all-cause mortality (95% CI: 1-22; P 5 0.033) and a 12% higher rate of cardiovascular events (95% CI: 0-26; P 5 0.044) after 76 months of follow up (40). In our study, approximately 50 cm 2 of VAT was associated with an increase in resting HR of 2.1 beats/min (95% CI: 1.3, 3.0; P < 0.001).…”

Section: Tablementioning

confidence: 96%

Body fat, especially visceral fat, is associated with electrocardiographic measures of sympathetic activation

Hillebrand

Mutsert

Christen

et al. 2014

Obesity

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Objective: Obesity is associated with sympathetic activation, but the role of different fat depots is unclear. The association between body fat, specifically visceral fat, and electrocardiographic measures of sympathetic activation in a population with structurally normal hearts was investigated. Methods: In this cross-sectional baseline analysis of the Netherlands Epidemiology of Obesity study, body fat percentage was assessed with BIA and abdominal subcutaneous (SAT) and visceral adipose tissue (VAT) with magnetic resonance (MR) imaging. Mean heart rate (HR) and five other electrocardiographic measures of sympathetic activation were calculated. We performed multivariate linear regression analyses. Results: In 868 participants with a mean age(SD) of 55(6) years, BMI of 26(4) kg/m 2 , 47% men, body fat was associated with HR and two other measures of sympathetic activation. Per sex-specific SD total body fat, the difference in HR was 1.9 beats/min (95% CI: 1.0, 2.9; P < 0.001) and per SD waist circumference 2.1 beats/min (95% CI: 1.3, 2.9; P < 0.001). The difference in HR per SD VAT was 2.1 beats/min (95% CI: 1.3, 3.0; P < 0.001). Conclusions: Body fat, especially visceral fat, was associated with electrocardiographic measures of sympathetic activation. Our study implies that already before the onset of cardiovascular disease, excess (visceral) body fat is associated with sympathetic activation.

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Section: Tablementioning

confidence: 96%

Body fat, especially visceral fat, is associated with electrocardiographic measures of sympathetic activation

Hillebrand

Mutsert

Christen

et al. 2014

Obesity

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“…First, measurement of resting heart rate is susceptible to numerous factors, 76 and nighttime heart rate was found to be a better prognostic variable relative to resting heart rate and 24-hour heart rate; nighttime heart rate should be a better measure of heart rate because both the interference of sensory input as well as physical and mental activities were minimized. 57 Second, patients with cardiovascular disease or subclinical cardiovascular disease with no antihypertensive treatment at baseline could have started taking heart rate-lowering medications during follow-up, and this would lead to an underestimation of the true magnitude of the observed associations. Third, although we extracted risks that reflected the greatest degree of control for potential confounders, the covariates adjusted and the extent to which they were adjusted varied in the original studies.…”

Section: Limitationsmentioning

confidence: 99%

Resting heart rate and all-cause and cardiovascular mortality in the general population: a meta-analysis

Zhang

Shen

2015

CMAJ

248

167

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Interpretation: Higher resting heart rate was independently associated with increased risks of all-cause and cardiovascular mortality. This indicates that resting heart rate is a predictor of all-cause and cardiovascular mortality in the general population. Abstract Research E54CMAJ, February 16, 2016, 188(3) traditional risk factors of cardiovascular disease on the association of resting heart rate with risk of all-cause and cardiovascular mortality. Methods Literature search and selectionWe searched PubMed, Embase and MEDLINE from inception to Jan. 1, 2015, restricting the search to studies involving humans and published in English or Chinese. Details of the search strategy are shown in Appendix 1 (available at www.cmaj.ca/lookup/suppl/doi:10.1503/ cmaj.150535/-/DC1). We reviewed the reference lists from retrieved articles to search for further relevant studies. Studies were included if they met the following criteria: the study group was the general population (i.e., excluding studies in disease-specific populations); the exposure of interest was resting heart rate; the outcome of interest was all-cause or cardiovascular mortality; age-or multivariateadjusted relative risk estimates with 95% confidence intervals (CIs) were provided; and the study used a prospective design. If data were duplicated in more than 1 study, we included the study with the longest follow-up duration. Two investigators (D.Z. and X.S) independently conducted the literature search and selection.

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“…1 High natural resting heart rate is associated with traditional risk factors for cardiovascular diseases, levels of inflammatory markers [2][3][4] and functional decline, 5 which suggests that resting heart rate might be related to the risk of various disease states. We previously found that resting heart rate was an independent predictor of total mortality related to cardiovascular disease in the general population.…”

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confidence: 99%

Association between resting heart rate and coronary artery disease, stroke, sudden death and noncardiovascular diseases: a meta-analysis

Zhang

Wang

2016

CMAJ

101

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Background:Resting heart rate is linked to risk of coronary artery disease, stroke, sudden death and noncardiovascular diseases. We conducted a meta-analysis to assess these associations in general populations and in populations of patients with hypertension or diabetes mellitus. Methods:We searched PubMed, Embase and MEDLINE from inception to Mar. 5, 2016. We used a random-effects model to combine studyspecific relative risks (RRs). We used restricted cubic splines to assess the dose-response relation. Results:We included 45 nonrandomized prospective cohort studies in the meta-analysis. The multivariable adjusted RR with an increment of 10 beats/min in resting heart rate was 1.12 (95% confidence interval [CI] 1.09-1.14) for coronary artery disease, 1.05 (95% CI 1.01-1.08) for stroke, 1.12 (95% CI 1.02-1.24) for sudden death, 1.16 (95% CI 1.12-1.21) for noncardiovascular diseases, 1.09 (95% CI 1.06-1.12) for all types of cancer and 1.25 (95% CI 1.17-1.34) for noncardiovascular diseases excluding cancer. All of these relations were linear. In an analysis by category of resting heart rate (< 60 [reference], 60-70, 70-80 and > 80 beats/min), the RRs were 0.99 (95% CI 0.93-1.04), 1.08 (95% CI 1.01-1.16) and 1.30 (95% CI 1.19-1.43), respectively, for coronary artery disease; 1.08 (95% CI 0.98-1.19), 1.11 (95% CI 0.98-1.25) and 1.08 (95% CI 0.93-1.25), respectively, for stroke; and 1.17 (95% CI 0.94-1.46), 1.31 (95% CI 1.12-1.54) and 1.57 (95% CI 1.39-1.77), respectively, for non cardiovascular diseases. After excluding studies involving patients with hypertension or diabetes, we obtained similar results for coronary artery disease, stroke and noncardiovascular diseases, but found no association with sudden death. Interpretation:Resting heart rate was an independent predictor of coronary artery disease, stroke, sudden death and noncardiovascular diseases over all of the studies combined. When the analysis included only studies concerning general populations, resting heart rate was not associated with sudden death. AbstractInfographic available at www.cmaj.ca/lookup/suppl

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Resting, night-time, and 24 h heart rate as markers of cardiovascular risk in middle-aged and elderly men and women with no apparent heart disease

Abstract: In middle-aged subjects with no apparent heart disease, all measures of increased HR were associated with increased mortality and CV risk. However, night-time HR was the only parameter with prognostic importance after multivariable adjustment.

Cited by 131 publications

References 25 publications

Body fat, especially visceral fat, is associated with electrocardiographic measures of sympathetic activation

Body fat, especially visceral fat, is associated with electrocardiographic measures of sympathetic activation

Resting heart rate and all-cause and cardiovascular mortality in the general population: a meta-analysis

Association between resting heart rate and coronary artery disease, stroke, sudden death and noncardiovascular diseases: a meta-analysis

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