Impact of changes in heart rate with age on all-cause death and cardiovascular events in 50-year-old men from the general population

Abstract

BackgroundResting heart rate (RHR), a known cardiovascular risk factor, changes with age. However, little is known about the association between changes in RHR and the risk of cardiovascular events. The purpose of this study was therefore to assess the impact of RHR at baseline, and the change in RHR over time, on the risk of all-cause death and cardiovascular events.DesignA random population sample of men born in 1943 who were living in Gothenburg, Sweden was prospectively followed for a 21-year period.MethodsParticipants were examined three times: first in 1993 and then re-examined in 2003 and 2014. At each visit, a clinical examination, an ECG and laboratory analyses were performed. Change in RHR between 1993 and 2003 was defined as a decrease if RHR decreased by 5 beats per minute (bpm), an increase if RHR increased by 5 bpm or stable if the RHR change was <4bpm).ResultsParticipants with a baseline RHR of >75 bpm in 1993 had about a twofold higher risk of all-cause death (HR 2.3, CI 1.2 to 4.7, p=0.018), cardiovascular disease (CVD) (HR 1.8, CI 1.1 to 3.0, p=0.014) and coronary heart disease (CHD) (HR 2.2, CI 1.1 to 4.5, p=0.025) compared with those with <55 bpm in 1993. Participants with a stable RHR between 1993 and 2003 had a 44% decreased risk of CVD (HR 0.56, CI 0.35 to 0.87, p=0.011) compared with participants with an increasing RHR. Furthermore, every beat increase in heart rate from 1993 was associated with a 3% higher risk for all-cause death, 1% higher risk for CVD and 2% higher risk for CHD.ConclusionHigh RHR was associated with an increased risk of death and cardiovascular events in men from the general population. Moreover, individuals with an increase in RHR between 50 and 60 years of age had worse outcome.

Evaluation of demographic, clinical characteristics, and the prescribing practice of guideline-directed medical therapy among chronic heart failure outpatients in multidisciplinary clinics in a large tertiary hospital: a retrospective audit of 1186 patients from 12 years

“…Compelling evidence exists regarding underutilization of β-blockers and failure to up-titration in CHF patients including older age (>70 years) and presence of respiratory disease [44], hypotension and polypharmacy [45], concern of side effects, contraindications, and poor experience of GPs [46] low HR and poor adherence to prescriptions [47]. Patients under β-blockers may experience adverse effectsmortality and cardiovascular events associated with high resting HR, as described by Chen et al 2019 [48]. Nevertheless, the reluctance of the clinicians to prescribe β-blockers due to potential side effects need further investigation.…”

Deviations from normal bedtimes are associated with short-term increases in resting heart rate

“…In a meta-analysis published in the European Heart Journal, several studies focused on reducing RHR over time through the use of beta-blockers and calcium channel blockers, finding the reductions in RHR were associated with reductions in cardiovascular mortality 10 . A prominent work recently published in Open Heart observed that individuals with significant increases in RHR over time were at higher risk for all-cause and cardiovascular mortality 11 , finding every beat per minute increase was associated with a 3% higher risk for all-cause mortality, 1% higher risk for cardiovascular disease and 1% higher risk for coronary heart disease. The authors also highlighted the clinical utility in capturing trends in RHR, rather than relying on a single measure.…”

“…A body of literature has shown RHR to be an important biomarker for cardiovascular health [8][9][10][11][12][13] . A meta-analysis conducted by Zhang et al 9 , including 46 studies involving 1,246,203 patients, observed that higher RHR was independently associated with increased risk of all-cause and cardiovascular mortality after adjusting for traditional risk factors 9 .…”

“…In addition to high RHR being a significant predictor of cardiovascular disease and mortality, studies have further shown that it is the changes in RHR over time that are associated with these outcomes 10,11 . In a meta-analysis published in the European Heart Journal, several studies focused on reducing RHR over time through the use of beta-blockers and calcium channel blockers, finding the reductions in RHR were associated with reductions in cardiovascular mortality 10 .…”

Is Heart Rate a Confounding Factor for Photoplethysmography Markers? A Systematic Review

“…There are numerous biological mechanisms that show that sympathetic stimulation promotes both acute and chronic insulin resistance and may increase risk of diabetes: (1) sympathetic stimulation promotes vasoconstriction and reduces skeletal muscle blood flow that causes a reduction of glucose uptake into the skeletal muscle [18]; (2) sympathetic activation inhibits pancreatic b cells to secret insulin [19]; and (3) sympathetic overactivity induces the renin-angiotensin-aldosterone system that leads to increasing of HR and causes insulin resistance [20]. People with an increase in RHR between 50 and 60 years of age had poorer effect [21].…”