Resting heart rate and incident venous thromboembolism: the Multi-Ethnic Study of Atherosclerosis

Abstract

ObjectiveVenous thromboembolism (VTE) is associated with significant morbidity and mortality. Resting heart rate (RHR), which may be modifiable through lifestyle changes, has been shown to be associated with cardiovascular disease risk and with inflammatory markers that have been predictive of VTE incidence.MethodsWe examined whether RHR is also associated with VTE incidence independent of these risk factors. We studied 6479 Multi-Ethnic Study of Atherosclerosis participants free from clinical VTE at baseline who had baseline RHR ascertained by 12-lead ECG. VTE events were recorded from hospital records and death certificates using International Classification of Diseases (ICD)-9 and ICD-10 codes. We categorised RHR as <60, 60–69, 70–79 and ≥80 bpm. We used Cox hazard models to determine the association of incident VTE by RHR.ResultsParticipants had mean (SD) age of 62 (10) years and RHR of 63 (10) bpm. RHR was cross-sectionally correlated with multiple inflammatory and coagulation factors. There were 236 VTE cases after a median follow-up of 14 years. Compared with those with RHR<60 bpm, the HR (95% CI) for incident VTE for RHR≥80 bpm was 2.08 (1.31 to 3.30), after adjusting for demographics, physical activity, smoking, diabetes and use of atrioventricular (AV)-nodal blockers, aspirin and anticoagulants, and remained significant after further adjustment for inflammatory markers (2.05 (1.29 to 3.26)). Results were similar after excluding those taking AV-nodal blocker medications. There was no effect modification of these associations by sex or age.ConclusionElevated RHR was positively associated with VTE incidence after a median of 14 years; this association was independent of several traditional VTE and inflammatory markers.

Resting heart rate and incidence of venous thromboembolism

“…They rested supine on the examination table while ARIC staff placed the electrodes and then for 2 to 3 additional minutes before the ECG was taken. Our initial focus was on Visit 1, but because associations differed markedly from MESA, we sought replication using ARIC Visit 4. We also picked Visit 4 because Visits 2 and 3 were too close to Visit 1, Visit 4 best matched the years of MESA and also had HRV data, and there have been too few VTEs so far after Visit 5.…”

“…We used 2 follow‐up time frames for analyses: (1) Visit 1 (1987‐1989) heart rate through 2015 and (2) Visit 4 (1999‐1996) heart rate through 2015 (more similar to the follow‐up time for MESA). For the Visit 1 start point, we excluded from the 15 792 ARIC participants 48 who were not black or white, 276 with prevalent VTE, 73 using anticoagulants, 105 with missing resting heart rate data, and 376 with missing covariate information, leaving 14 914 for analysis.…”

“…We categorized resting heart rate as ≤60, 60 to 69, 70 to 79, or ≥80 bpm, as done in MESA, and compared participant characteristics (means or frequencies) across these categories to identify possible confounding variables. We plotted Kaplan‐Meier and restricted cubic spline curves to illustrate the cumulative incidence of VTE by heart rate categories.…”

“…Considerable epidemiologic evidence has indicated that a higher resting heart rate is a risk factor for arterial cardiovascular diseases, total mortality, higher blood pressure, lower physical fitness, and higher inflammatory markers in the general population . Yet, to our knowledge, only the prospective Multi‐Ethnic Study of Atherosclerosis (MESA) has examined whether higher resting heart rate is a risk factor for venous thromboembolism (VTE—deep vein thrombosis [DVT] or pulmonary embolism [PE]) . MESA participants with a resting heart rate ≥80 beats per minutes (bpm) had double the risk of hospitalized VTE—as documented via discharge codes—compared to participants with a heart rate <60 bpm …”

“…Yet, to our knowledge, only the prospective Multi‐Ethnic Study of Atherosclerosis (MESA) has examined whether higher resting heart rate is a risk factor for venous thromboembolism (VTE—deep vein thrombosis [DVT] or pulmonary embolism [PE]) . MESA participants with a resting heart rate ≥80 beats per minutes (bpm) had double the risk of hospitalized VTE—as documented via discharge codes—compared to participants with a heart rate <60 bpm …”