What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Cognitive decline and dementia (n=53621). Intervention: Increased resting heart rate vs. Lower resting heart rate. Primary outcome: Incidence of cognitive decline, including dementia (RR 1.18, 95% CI 1.04-1.33).

January 1, 2022Open Access

Resting Heart Rate and Cognitive Decline: A Meta-Analysis of Prospective Cohort Studies

Key Result

Increased resting heart rate was significantly associated with a higher risk of cognitive decline (RR 1.18).

Study Design

Type

Meta-Analysis (n=53,621)

Structured PICO

Does increased resting heart rate increase the risk of cognitive decline and dementia?

Population

53,621 participants from 7 prospective cohort studies

Intervention

Increased resting heart rate (RHR)

Comparator

Lower resting heart rate

Outcome

Incidence of cognitive decline, including dementiahard clinical

Higher resting heart rate is associated with an increased risk of cognitive decline and dementia, suggesting a potential link between autonomic nerve activity and cognitive health.

Main Result

Effect estimate: RR 1.18 (95% CI 1.04-1.33)

Limitations

Small number of available prospective cohort studies and relatively small patient sample.
High heterogeneity was found in the primary analysis and most subgroup analyses.
Most studies assessed RHR only once at baseline and once during the follow-up period.
Several pivotal factors related to RHR and cognitive decline (e.g., anxiety, stress, medications) were not adjusted for.
Publication bias was identified.

Abstract

BACKGROUND AND PURPOSE: Several previous meta-analyses have identified an association between cognitive decline and heart rate variability, which reflects autonomic nerve activity. This systematic review and meta-analysis investigated the impact of increased resting heart rate (RHR) on the incidence of cognitive decline, including dementia. METHODS: The PubMed, Embase, and PsycInfo databases were searched for relevant prospective cohort studies published before April 18, 2022. A methodological quality assessment of the included studies was conducted using the Newcastle-Ottawa Scale. Summary estimates of the incidence of cognitive decline, including dementia, were generated using a random-effects model. Potential publication bias was evaluated using Begg's funnel plots and Egger's regression tests. RESULTS: The meta-analysis included 7 prospective cohort studies comprising 53,621 participants. A weak significant association was observed between RHR and the risk of cognitive decline, although the analysis indicated high heterogeneity among the studies (relative risk=1.18, 95% confidence interval=1.04-1.33, I²=82.5%). Significant associations were determined between RHR and all combined types of dementia except for Alzheimer's disease and mild cognitive impairment. There was also a dose-response association between increased RHR and cognitive decline. The meta-estimate of the cognitive decline risk associated with a 10 beat-per-minute increase in RHR was 1.06, and it was 1.10 for dementia. CONCLUSIONS: This study found that a higher RHR was associated with an increased cognitive decline risk. Due to study limitations such as publication bias and high heterogeneity, additional studies are required to validate this finding. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration number CRD42021282912.

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