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. 2015 Jan;101(2):132-8.
doi: 10.1136/heartjnl-2014-306046. Epub 2014 Sep 11.

Variation in resting heart rate over 4 years and the risks of myocardial infarction and death among older adults

James S Floyd  1 , Colleen M Sitlani  1 , Kerri L Wiggins  1 , Erin Wallace  2 , Astrid Suchy-Dicey  2 , Siddique A Abbasi  3 , Mercedes R Carnethon  4 , David S Siscovick  5 , Nona Sotoodehnia  1 , Susan R Heckbert  6 , Barbara McKnight  7 , Kenneth M Rice  7 , Bruce M Psaty  5
Affiliations

Variation in resting heart rate over 4 years and the risks of myocardial infarction and death among older adults

James S Floyd et al. Heart. 2015 Jan.

Abstract

Objective: Resting heart rate (RHR) is an established predictor of myocardial infarction (MI) and mortality, but the relationship between variation in RHR over a period of several years and health outcomes is unclear. We evaluated the relationship between long-term variation in RHR and the risks of incident MI and mortality among older adults.

Methods: 1991 subjects without cardiovascular disease from the Cardiovascular Health Study were included. RHR was taken from resting ECGs at the first five annual study visits. RHR mean, trend and variation were estimated with linear regression. Subjects were followed for incident MI and death until December 2010. HRs for RHR mean, trend and variation are reported for differences of 10 bpm, 2 bpm/year and 2 bpm, respectively.

Results: 262 subjects had an incident MI event (13%) and 1326 died (67%) during 12 years of median follow-up. In primary analyses adjusted for cardiovascular risk factors, RHR mean (HR 1.12; 95% CI 1.05 to 1.20) and variation (HR 1.08; 95% CI 1.03 to 1.13) were associated with the risk of death while trend was not. None of the RHR variables were significantly associated with the risk of incident MI events; however, CIs were wide and the MI associations with RHR variables were not significantly different from the mortality associations. Adjusting for additional variables did not affect estimates, and there were no significant interactions with sex.

Conclusions: Variation in RHR over a period of several years represents a potential predictor of long-term mortality among older persons free of cardiovascular disease.

Keywords: MYOCARDIAL ISCHAEMIA AND INFARCTION (IHD).

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Figures

Figure 1
Figure 1
Diagram of resting heart rate (RHR) measurements from baseline study visits. RHR trend is the slope of the line of best fit and RHR variation is the square root of the variance from the five residuals (the root mean squared error).
Figure 2
Figure 2
Forest plots of hazard ratios for resting heart rate variable associations with outcomes. (A) Hazard ratios for RHR mean. (B) Hazard ratios for RHR trend. (C) Hazard ratios for RHR variation.
Figure 2
Figure 2
Forest plots of hazard ratios for resting heart rate variable associations with outcomes. (A) Hazard ratios for RHR mean. (B) Hazard ratios for RHR trend. (C) Hazard ratios for RHR variation.
Figure 2
Figure 2
Forest plots of hazard ratios for resting heart rate variable associations with outcomes. (A) Hazard ratios for RHR mean. (B) Hazard ratios for RHR trend. (C) Hazard ratios for RHR variation.
See this image and copyright information in PMC

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