Key result
Resting heart rate ≤70 bpm is linked to ~2-fold higher cognitive impairment risk in older females.
Why the study?
Evidence linking resting heart rate to cognitive impairment remains inconsistent, and sex and age differences in cardiovascular regulation and cognitive function may modify this association.
Cross-Sectional (n=1,309)
No
Odds Ratio: 2.061 (95% CI 1.225–3.467)
Absolute Event Rate: 19.3% vs 10.7%
p-value: p=0.006
There is a U-shaped relationship between resting heart rate and cognitive impairment specifically in women aged 50-69 years, suggesting that demographic heterogeneity is critical when evaluating heart rate as a risk factor for cognitive decline.
Low resting heart rate may associate with cognitive impairment in women aged 50-69; hypothesis-generating and requires prospective validation before any clinical consideration.
Resting heart rate (RHR) is an important risk factor for cardiovascular diseases (CVD) and has been linked to cognitive impairment (CI), but evidences remain inconsistent. Given that both cardiovascular regulation and cognitive function differ by sex and age, these factors may modify the RHR–CI association. This study aimed to examine this relationship and its potential sex- and age-specific differences in a general Chinese population. This population-based cross-sectional study included 1309 participants from rural areas of northwestern China. RHR was obtained from a standard 12-lead electrocardiogram. CI was diagnosed with Mini-Mental State Examination scores below the cutoff value. RHR data were fitted as restricted cubic spline to explore potential non-linear relationships. Stratified analyses by sex, age (50–69 years vs ≥ 70 years) and combined were performed. Two hundred twenty five (17.2%) participants met criteria for CI. We found an independent and prominent U-shaped relationship between RHR and CI in female within 50–69 years (P overall = 0.01, P non-linear = 0.003), while other subgroups showed no significant relations. Further results showed that in female within 50–69 years, both lower (≤ 70 bpm) and higher RHR group (≥ 81 bpm) were associated with increased risk for CI (vs. 71–80 bpm) (≤ 70 bpm vs 71–80 bpm vs ≥ 81 bpm: 19.3% vs 10.7% vs 18.5%, P = 0.011; ≤ 70 bpm vs 71-80 bpm: OR = 2.061(1.225–3.467), P = 0.006; ≥ 81 bpm vs 71-80 bpm: OR = 1.692(0.949–3.015), P = 0.075). This association remained significant after excluding participants with abnormal RHR or with CVD or cerebrovascular diseases. The relationship between RHR and CI was highly dependent on sex and age. An independently U-shaped relationship existed only in female within 50–69 years, but no relations were found in other participants. These findings highlight the importance of considering demographic heterogeneity when evaluating the relationship between RHR and CI.
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Shang et al. (2026) conducted a cross-sectional in Cognitive impairment (n=1,309). Resting heart rate ≤70 bpm vs. Resting heart rate 71-80 bpm was evaluated on Cognitive impairment (MMSE score below education-adjusted cutoff) (OR 2.061, 95% CI 1.225-3.467, p=0.006). In females aged 50 to 69 years, resting heart rate exhibited a U-shaped relationship with cognitive impairment, with rates ≤70 bpm significantly increasing the risk compared to 71-80 bpm (OR 2.061).
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