Resting Heart Rate for Global Health Surveillance: Descriptive Epidemiology of 566,986 Participants from the WHO STEP Surveys and the South Asia Biobank

This is the authors' abstract. We don't add key points for this paper.

Objective: To describe global patterns of resting heart rate (RHR) in population subgroups and over time. Methods: Observational data from WHO STEP surveys (n=363,462 participants from 76 countries, 2002-2020) and the South Asia Biobank (SAB, n=203,524 participants from four South Asian countries, 2018-2023). RHR was measured in triplicate while seated using a blood pressure cuff. Height and weight were measured using anthropometric techniques. Physical activity was self-reported and accelerometry-measured (SAB subsample, n=22,183). We describe RHR distributions by geographical region, temporality, sex, age, BMI, and physical activity. Utility of RHR to explain accelerometer-based physical activity was examined by regression. Results: Country-level median RHR ranged 65-80 bpm, higher in women than men. Age-related RHR patterns diverged markedly by sex; men showing a curvilinear association with higher RHR in midlife, and women showing a consistent decline with age across most regions. Compared to normal-weight, obese participants had higher RHR [WHO: (men: +4.4 bpm, women: +0.9 bpm), SAB: (men: +3.1 bpm, women: +1.0 bpm)]. Participants meeting physical activity recommendations had lower RHR [WHO: (men: -1.6 bpm, women: -0.9 bpm), SAB: (men: -2.1 bpm, women: -0.5 bpm)] compared to insufficiently active. In SAB (field-work spanning whole-calendar year), seasonal variations were present (0.6-0.9 bpm higher RHR in June-August compared to September-November), most pronounced further from the equator. In 21 WHO countries with repeat survey data, RHR was stable over time in women but declined in men (-0.4 bpm/year). Self-reported activity explained 2-14% (women: 2-3%, men: 10-14%) of the variance in device-measured physical activity, and RHR added 1-3% incrementally. Conclusions: RHR varies globally, exhibits different age-related patterns by sex, and is higher in population subgroups with greater non-communicable disease burden. RHR is easy to measure and may have utility for global health surveillance.