What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: General population (n=1246203). Intervention: Higher resting heart rate vs. Lower resting heart rate. Primary outcome: All-cause mortality (RR 1.09, 95% CI 1.07-1.12).

November 23, 2015Open Access

Resting heart rate and all-cause and cardiovascular mortality in the general population: a meta-analysis

Key Result

A 10 beats/min increment in resting heart rate was associated with a 9% increased risk of all-cause mortality (RR 1.09) and an 8% increased risk of cardiovascular mortality (RR 1.08).

Study Design

Type

Meta-Analysis (n=1,246,203)

Structured PICO

Does higher resting heart rate increase the risk of all-cause and cardiovascular mortality in the general population?

Population

General population from 46 prospective cohort studies (n=1,246,203 for all-cause mortality; n=848,320 for cardiovascular mortality)

Intervention

Higher resting heart rate (evaluated as 10 beats/min increments, 60-80 beats/min, and >80 beats/min)

Comparator

Lowest category of resting heart rate (or 45 beats/min)

Outcome

All-cause mortality and cardiovascular mortalityhard clinical

Higher resting heart rate is independently associated with increased risks of all-cause and cardiovascular mortality in the general population.

Main Result

Effect estimate: RR 1.09 (95% CI 1.07-1.12)

Limitations

Measurement of resting heart rate is susceptible to numerous factors
Potential initiation of heart rate-lowering medications during follow-up could lead to underestimation of true magnitude
Variation in adjusted covariates across original studies
Substantial between-study heterogeneity not explained by a single factor
Search restricted to English and Chinese languages, with publication bias detected

Abstract

BACKGROUND: Data on resting heart rate and risk of all-cause and cardiovascular mortality are inconsistent; the magnitude of associations between resting heart rate and risk of all-cause and cardiovascular mortality varies across studies. We performed a meta-analysis of prospective cohort studies to quantitatively evaluate the associations in the general population. METHODS: We searched PubMed, Embase and MEDLINE from inception to Jan. 1, 2015. We used a random-effects model to combine study-specific relative risks and 95% confidence intervals (CIs). We used restricted cubic spline functions to assess the dose-response relation. RESULTS: A total of 46 studies were included in the meta-analysis, involving 1 246 203 patients and 78 349 deaths for all-cause mortality, and 848 320 patients and 25 800 deaths for cardiovascular mortality. The relative risk with 10 beats/min increment of resting heart rate was 1.09 (95% CI 1.07-1.12) for all-cause mortality and 1.08 (95% CI 1.06-1.10) for cardiovascular mortality. Compared with the lowest category, patients with a resting heart rate of 60-80 beats/min had a relative risk of 1.12 (95% CI 1.07-1.17) for all-cause mortality and 1.08 (95% CI 0.99-1.17) for cardiovascular mortality, and those with a resting heart rate of greater than 80 beats/min had a relative risk of 1.45 (95% CI 1.34-1.57) for all-cause mortality and 1.33 (95% CI 1.19-1.47) for cardiovascular mortality. Overall, the results did not differ after adjustment for traditional risk factors for cardiovascular disease. Compared with 45 beats/min, the risk of all-cause mortality increased significantly with increasing resting heart rate in a linear relation, but a significantly increased risk of cardiovascular mortality was observed at 90 beats/min. Substantial heterogeneity and publication bias were detected. INTERPRETATION: Higher resting heart rate was independently associated with increased risks of all-cause and cardiovascular mortality. This indicates that resting heart rate is a predictor of all-cause and cardiovascular mortality in the general population.

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