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Resting heart rate is an independent predictor of all-cause mortality in the middle aged general population

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Abstract

Background

High resting heart rate (RHR) predicts cardiovascular outcomes in patients with vascular disease and heart failure. We evaluated the prognostic value of RHR in a large contemporary population-based, prospective cohort of individuals without known coronary artery disease.

Methods and results

Resting heart rate (RHR) was determined in 4091 individuals (mean age 59.2 ± 7.7; 53 % women) from the Heinz Nixdorf RECALL study, of whom, 3348 were free of heart rate lowering medication. During 10.5 years of follow-up (median), 159 (3.9 %) individuals developed a coronary event and 398 (9.7 %) died of any cause. Persons without any event (n = 3603) had similar heart rates as persons with coronary events (69.5 ± 11 versus 69.9 ± 11 bpm, p = 0.51) but lower heart rates than persons who died (72.3 ± 13 bpm, p < 0.0001). In individuals without heart rate lowering medication, an increase in heart rate by 5 bpm was associated with an increased hazard ratio (HR) for all-cause mortality of 13 % in unadjusted analysis and also upon adjustment for traditional cardiovascular risk factors, including coronary artery calcification [full model: HR (95 % CI) 1.13 (1.07–1.20), p < 0.0001], but not for coronary events [HR 1.02 (0.94–1.11), p = 0.60]. In individuals without heart rate lowering medication, the HR (full model) for heart rate ≥70 versus <70 bpm with regard to all-cause mortality and coronary events was 1.68 (1.30–2.18), p < 0.0001, and 1.20 (0.82–1.77), p = 0.35. Analysis of the entire cohort revealed a continuous relationship of heart rate with all-cause mortality [HR for lowest to highest heart rate quartile 1.64 (1.22–2.22), p = 0.001, full model] but not with coronary events [HR 1.04 (0.65–1.66), p = 0.86].

Conclusions

In the general population without known coronary artery disease and heart rate lowering medication, elevated RHR is an independent risk marker for all-cause mortality but not for coronary events.

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Abbreviations

CAC:

Coronary artery calcium

CAD:

Coronary artery disease

CVD:

Cardiovascular disease

PAD:

Peripheral arterial disease

RHR:

Resting heart rate

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Acknowledgments

We thank the Heinz Nixdorf Foundation Germany, for their generous support of this study. This study is also supported by the German Ministry of Education and Science (BMBF), and the German Aerospace Center (Deutsches Zentrum für Luft- und Raumfahrt, DLR), Bonn, Germany. We thank Prof. K. Lauterbach (Department of Health Economy and Epidemiology, University of Cologne, Germany) for his valuable contributions in an earlier phase of the study. Assessment of psychosocial factors and neighborhood level information is funded by the German Research Council (DFG; Project SI 236/8-1 and SI 236/9-1). We acknowledge the support of the Sarstedt AG & Co. (Nümbrecht, Germany) concerning laboratory equipment. We are indebted to all study participants and to both the dedicated personnel of the study center of the Heinz Nixdorf Recall study and the EBT-scanner facilities and to the investigative group, in particular to U. Slomiany, E. M. Beck, A. Öffner, S. Münkel, S. Schrader, R. Peter, and H. Hirche.

Advisory Board: Meinertz T., Hamburg, Germany (Chair); Bode C., Freiburg, Germany; deFeyter P. J., Rotterdam, Netherlands; Güntert B, Halli, Austria; Gutzwiller F., Bern, Switzerland; Heinen H., Bonn, Germany; Hess O., Bern, Switzerland; Klein B., Essen, Germany; Löwel H., Neuherberg, Germany; Reiser M., Munich, Germany; Schmidt G., Essen, Germany; Schwaiger M., Munich, Germany; Steinmüller C., Bonn, Germany; Theorell T., Stockholm, Sweden; Willich S. N., Berlin, Germany.

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Authors and Affiliations

  1. Clinic of Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, Saarland University Clinic, Homburg, Saar, Germany

    Florian Custodis, Ulrich Laufs & Michael Böhm

  2. Institute for Medical Informatics, Biometry and Epidemiology, University Clinic Essen, Essen, Germany

    Ulla Roggenbuck, Nils Lehmann, Susanne Moebus & Karl-Heinz Jöckel

  3. Clinic of Cardiology, West-German Heart and Vascular Center Essen, University Clinic Essen, Essen, Germany

    Amir-Abbas Mahabadi, Raimund Erbel & Stefan Möhlenkamp

  4. Institute for Pathophysiology, West-German Heart and Vascular Center Essen, University Clinic Essen, Essen, Germany

    Gerd Heusch

  5. Institute of Clinical Chemistry and Laboratory Medicine, University Clinic Essen, Essen, Germany

    Klaus Mann

  6. Clinic of Cardiology and Intensive Care Medicine, Bethanien Hospital Moers, Bethanienstrasse 21, 47441, Moers, Germany

    Stefan Möhlenkamp

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  1. Florian Custodis
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  2. Ulla Roggenbuck
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  9. Karl-Heinz Jöckel
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  11. Michael Böhm
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  12. Stefan Möhlenkamp
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Corresponding author

Correspondence to Stefan Möhlenkamp.

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Conflict of interest

None of the authors have declared a conflict of interest or financial disclosures related to the study. Statistical analysis was supported by a grant by SERVIER Deutschland GmbH Germany.

Ethical standards

All patients gave informed consent prior to their inclusion in the study; the study protocol conformed to the ethical guidelines of the 1964 Declaration of Helsinki and its later amendments.

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On behalf of the Heinz Nixdorf Recall Study Investigators.

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Custodis, F., Roggenbuck, U., Lehmann, N. et al. Resting heart rate is an independent predictor of all-cause mortality in the middle aged general population. Clin Res Cardiol 105, 601–612 (2016). https://doi.org/10.1007/s00392-015-0956-7

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