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

• Published in: Clinical research in cardiology Vol. 110; no. 6; pp. 822 - 830
• Main Authors: Cui, Xiaotong, Mandalenakis, Zacharias, Thunström, Erik, Fu, Michael, Svärdsudd, Kurt, Hansson, Per-Olof
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.06.2021; Springer Nature B.V
• Subjects: Cardiology; Cardiology and Cardiovascular Disease; Cardiovascular diseases; Cell and Molecular Biology; Cell- och molekylärbiologi; Cohort analysis; Cohort study; Confidence intervals; General population; Heart rate; Kardiologi och kardiovaskulära sjukdomar; Medicine; Medicine & Public Health; Middle age; Mortality; Original Paper; Population; Statistical models; Heart rate; General population; Mortality; Cohort study
• ISSN: 1861-0684; 1861-0692; 1861-0692
• DOI: 10.1007/s00392-020-01714-w

Background A 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. Methods A 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. Results A 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. 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. Graphic abstract