The impact of time-updated resting heart rate on cause-specific mortality in a random middle-aged male population: a lifetime follow-up

Xiaotong Cui,Michael Fu,Per-Olof Hansson,Kurt Svärdsudd,Zacharias Mandalenakis,Erik Thunström

doi:10.1007/s00392-020-01714-w

Abstract

BackgroundA high resting heart rate (RHR) is associated with an increase in adverse events. However, the long-term prognostic value in a general population is unclear. We aimed to investigate the impact of RHR, based on both baseline and time-updated values, on mortality in a middle-aged male cohort.MethodsA random population sample of 852 men, all born in 1913, was followed from age 50 until age 98, with repeated examinations including RHR over a period of 48 years. The impact of baseline and time-updated RHR on cause-specific mortality was assessed using Cox proportional hazard models and cubic spline models.ResultsA baseline RHR of ≥ 90 beats per minute (bpm) was associated with higher all-cause mortality, as compared with an RHR of 60–70 bpm (hazard ratio [HR] 1.60, 95% confidence interval [CI] 1.17–2.19, P = 0.003), but not with cardiovascular (CV) mortality. A time-updated RHR of < 60 bpm (HR 1.41, 95% CI 1.07–1.85, P = 0.014) and a time-updated RHR of 70–80 bpm (HR 1.34, 95% CI 1.02–1.75, P = 0.036) were both associated with higher CV mortality as compared with an RHR of 60–70 bpm after multivariable adjustment. Analyses using cubic spline models confirmed that the association of time-updated RHR with all-cause and CV mortality complied with a U-shaped curve with 60 bpm as a reference.ConclusionIn this middle-aged male cohort, a time-updated RHR of 60–70 bpm was associated with the lowest CV mortality, suggesting that a time-updated RHR could be a useful long-term prognostic index in the general population.Graphic abstract

Highlights

MethodsAn elevated resting heart rate (RHR) is related to both increased cardiovascular (CV) morbidity and mortality in the general population [1,2,3,4,5,6,7,8,9,10]
The all-cause mortality incidence in those with an RHR of ≥ 90 bpm increased by 60% (HR 1.60, 95% confidence interval (CI) 1.17–2.19, P = 0.003) as compared with the group of men with an RHR of 60–70 bpm
Omlor et al found that the risk of all-cause mortality in chronic obstructive pulmonary disease (COPD) patients increased by 79% in those with a time-updated RHR of > 72 bpm compared with an RHR of ≤ 72 bpm [17]

Summary

Introduction

MethodsAn elevated resting heart rate (RHR) is related to both increased cardiovascular (CV) morbidity and mortality in the general population [1,2,3,4,5,6,7,8,9,10]. It has recently been demonstrated that an increase in time-updated RHR is associated with a higher risk of mortality in patients with heart failure or with chronic obstructive pulmonary disease (COPD) [15,16,17]. Whether this relationship exists in the general population remains unknown. Conclusion In this middle-aged male cohort, a time-updated RHR of 60–70 bpm was associated with the lowest CV mortality, suggesting that a time-updated RHR could be a useful long-term prognostic index in the general population

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