Abstract 14188: Is Resting Heart Rate Really Associated With Cardiovascular Mortality?
Introduction: The association between an increased resting heart rate (RHR) and elevated mortality has been described in many, but not all observational studies comprising patients with and without heart failure. We therefore aimed to evaluate the association of RHR and long-term cardiovascular(CV) mortality risk in a large well phenotyped cohort of patients.
Methods: A total of 3316 patients (age=62.1±10.7years; females=30.6%; mean follow up: 9.9years) who underwent coronary angiography were included in the analyses. In the morning, RHR was measured five times after 30 seconds apart, following a ten-minute rest in the supine position, with the average derived from the last two measurements. The cohort was separated in predefined subgroups, according to NTproBNP (n=3265; median=293.0 ng/ml) levels and angiographic left ventricular ejection fraction (LVEF;n=1360;mean=59.63±17.39%). We performed a stepwise backwards Cox-regression analysis adjusted for age, sex, smoking status, diabetes, systolic blood pressure, serum creatinine, LDL, HDL and ongoing medication.
Results: Participants with NTproBNP levels below 293ng/mL (mean RHR=67.9±11.1 bpm)showed a significant association between a higher resting heart rate and lower CV mortality (Hazard Ratio (HR):0.12; 95%CI:0.01-0.85; p=0.035). Similarly, in patients with a LVEF above 50% (mean RHR=68.0±11.4 bpm) risk of CV death decreased by 6% (HR:0.06; 95%CI:0.01-0.69; p=0.024;) per increase of log-RHR . Additional adjustment for physical activity and noradrenaline as well as exclusion of patients with atrial fibrillation (n=397) did not materially change these associations.
Conclusion: In a multivariate prospective analysis adjusted for various confounders higher RHR is consistently related to decreased CV mortality risk in patients with normal LV systolic function and low NTproBNP levels. This novel and controversial finding challenges the current view of an elevated RHR as a global CV risk factor in patients without systolic heart failure and warrants further research.
- © 2013 by American Heart Association, Inc.