Both low (<50 bpm) and high (≥90 bpm) resting heart rates increased the risk of incident stroke compared to 60-69 bpm (HR 1.29 and HR 1.17, respectively; P<0.001 for both).
Cohort (n=460,554)
Sí
Does baseline resting heart rate predict the risk of incident stroke in a community-based cohort?
Resting heart rate exhibits a U-shaped relationship with incident stroke risk, independent of atrial fibrillation, with both low (<50 bpm) and high (≥90 bpm) rates increasing risk.
Estimación del efecto: HR 1.29 (95% CI 1.17-1.43)
Tasa de eventos absoluta: 236% vs 173%
valor p: p=<0.001
Abstract Background and aims Elevated heart rate is associated with hypertension and poor cardiovascular health, but low heart rates may reflect either cardiovascular fitness or disease, may predispose to paroxysmal atrial fibrillation (AF) and are associated with increased cerebral pulsatility and thus small vessel disease. However, the relationship with stroke risk is unclear. We determined these relationships in UK Biobank. Methods UK-Biobank is a large, community-based, longitudinal cohort recruiting 500,000 UK participants since 2007, with face-to-face assessment and healthcare data-linkage. Associations between baseline heart-rate and stroke were determined by incidence rate and Cox proportional hazards regression, unadjusted and adjusted for age, sex and cardiovascular risk factors, including AF at any time. Results Over 13.2 years (6.1 million person-years), 11,733 strokes occurred among 460,554 participants (194/100,000 person-years). Risk of stroke was lowest with baseline heart rates of 60–69 bpm (173/100,000Pyrs) and increased at both low (50 bpm) and high (≥90 bpm) heart rate (236 and 271/100,000Pyrs), quadratic P 0.001. After full adjustment, low heart-rate was significantly associated with stroke risk (HR 1.29, 95%CI 1.17–1.43, P 0.001) as was high heart-rate (HR 1.17, 95%CI 1.08–1.27, P 0.001). In stratified analyses, the U-shaped pattern was only significant in participants without AF (n = 458,098), with no significant interaction between heart rate and AF (P = 0.078). Conclusions Resting heart rate demonstrates a significantly U-shaped relationship with incident stroke, independent of a diagnosis of AF. Whether low heart rates are a marker of cardiovascular dysfunction or could have a causal role is unclear in the absence of interventional studies. Conflict of interest Dexter Penn: nothing to disclose. Figure 1 - belongs to Methods Figure 2 - belongs to Results
Penn et al. (Fri,) conducted a cohort in Stroke (n=460,554). Low (<50 bpm) and high (≥90 bpm) resting heart rate vs. Resting heart rate 60-69 bpm was evaluated on Incident stroke (HR 1.29, 95% CI 1.17-1.43, p=<0.001). Both low (<50 bpm) and high (≥90 bpm) resting heart rates increased the risk of incident stroke compared to 60-69 bpm (HR 1.29 and HR 1.17, respectively; P<0.001 for both).