Abstract
BackgroundHigher, but also lower resting heart rate (HR), has been associated with increased cardiovascular events and mortality. Little is known about the interplay between HR, cardiovascular risk factors, concomitant diseases, vascular (endothelial) function, neurohormonal biomarkers, and all-cause mortality in the general population. Thus, we aimed to investigate these relationships in a population-based cohort.Methods15,010 individuals (aged 35–74 at enrolment in 2007–2012) from the Gutenberg Health Study were analyzed. Multivariable regression modeling was used to assess the relation between the variables and conditional density plots were generated for cardiovascular risk factors, diseases, and mortality to show their dependence on HR.ResultsThere were 714 deaths in the total sample at 7.67 ± 1.68 years of follow-up. The prevalence of diabetes mellitus, arterial hypertension, coronary and peripheral artery disease, chronic heart failure, and previous myocardial infarction exhibited a J-shaped association with HR. Mortality showed a similar relation with a nadir of 64 beats per minute (bpm) in the total sample. Each 10 bpm HR reduction in HR < 64 subjects was independently associated with increased mortality (Hazard Ratio 1.36; 95% confidence interval 1.06–1.75). This increased risk was also present in HR > 64 subjects (Hazard Ratio 1.29; 95% confidence interval 1.19–1.41 per 10 bpm increase in HR). Results found for vascular and neurohormonal biomarkers exhibited a differential picture in subjects with a HR below and above the nadir.DiscussionThese results indicate that in addition to a higher HR, a lower HR is associated with increased mortality.
Highlights
Higher, and lower resting heart rate (HR), has been associated with increased cardiovascular events and mortality
We found diabetes mellitus and arterial hypertension exhibited a J-shaped curve with the highest proportions in individuals with higher HR
The results of the present investigation demonstrate for the first time that in a large population-based cohort, in addition to a higher HR, a lower HR is associated with increased all-cause mortality after adjustment for age, sex, CV risk factors, concomitant disease, and HR-associated medication
Summary
Lower resting heart rate (HR), has been associated with increased cardiovascular events and mortality. For many years, increased heart rate (HR) has been demonstrated to be associated with increased cardiovascular (CV) mortality in patients with coronary artery disease (CAD) [1] and with chronic heart failure (CHF) [2]. Pharmacological HR reduction with agents such as the If-channel inhibitor, ivabradine, has been shown to reduce angina symptoms in patients with CAD [4] and to improve both congestive symptoms as well as prognosis in patients with CHF [5]. Based on this literature, it has been proposed that an elevated HR may be considered an independent CV risk factor [6]. In contrast to the literature outlined above, recent studies in CAD patients
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Schedule a callMore From: Clinical research in cardiology : official journal of the German Cardiac Society
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