Higher Resting Heart Rate Associated With Adverse CV, Non-CV Events

Higher resting heart rate (HR) and increases in HR over time are associated with increased risk of adverse cardiovascular (CV) and non-CV events, according to a study published in JAMA Cardiology.

Resting HR is a known risk factor for adverse outcomes in both individuals with CV disease and the overall population, according to the authors of the study. In addition, the association between changes in HR and mortality has been assessed in individuals without known CV disease and in those with hypertension.

“The availability of strategies to monitor and track HR provides a logical rationale for determining the utility of temporal changes in HR as a biomarker for severity of CV or non-CV disease,” wrote the authors.

The authors used a time-updated approach to determine whether actual temporal changes in HR from the preceding visit are of prognostic importance. A total of 15,680 participants enrolled in the Atherosclerosis Risk in Communities cohort study were included. The participants underwent an evaluation of CV risk factors during 4 separate visits from 1987 to 1998, with a median interval between visits of 3 years. The participants were followed up until December 31, 2014.

Of the patients, 5451 (34.9%) had hypertension at the baseline visit, 1646 (10.5%) were taking β-blocker therapy, 538 (3.4%) were taking calcium-channel blockers, and 248 (1.6%) were taking digoxin. At follow-up visits, the authors observed an increase in body mass index, prevalence of hypertension and diabetes, and the use of β-blockers and calcium-channel blockers.

During the 28 years of follow-up, 6467 participants died, and 2939 experienced incident heart failure (HF). Increase in HR from the preceding visit were associated with all outcome measures: all-cause mortality, incident heart failure, myocardial infarction, stroke, CV death, non-CV death, and cancer death.

Results showed that each increase of 5 beats per minute in HR was associated with:

• 12% (95% Cl, 10%-15%) higher risk of all-cause mortality
• 13% (95% Cl, 9%-16%) higher risk of incident HF
• 9% (95% Cl, 4%-13%) higher risk of myocardial infarction
• 6% (95% Cl, 1%-11%) higher risk of stroke
• 13% (95% Cl, 8%-17%) higher risk of CV death
• 12% (95% Cl, 10%-15%) higher risk of non-CV death
• 8% (95% Cl, 3%-13%) higher risk of cancer death

The association between change in HR and all-cause mortality was linear. Any rise in HR above a preceding HR value was associated with elevated risk, and any drop in HR from a preceding HR value was associated with lower risk.

"Our findings further support the importance of measuring resting HR in everyday clinical practice, and potentially with remote monitoring, as a way to identify individuals who could be at greatest risk of CV and non-CV events,” concluded the authors.

References

Vazir A, Claggett B, Cheng S, et al. Association of resting heart rate and temporal changes in heart rate with outcomes in participants of the atherosclerosis risk in communities study. JAMA Cardiol. Published online January 24, 2018.