Resting heart rate and cause-specific death in a 16.5-year cohort study of the Japanese general population

doi:10.1016/j.ahj.2003.12.020

American Heart Journal

Volume 147, Issue 6, June 2004, Pages 1024-1032

https://doi.org/10.1016/j.ahj.2003.12.020 Get rights and content

Abstract

Background

Several prospective studies have reported resting heart rate (HR) to be a risk factor for certain cause-specific death, together with sex- or age-specific differences in the effects of HR on death. However, there have been few prospective data from non-Western populations.

Methods

Cohort study, over 16.5 years to date of death or end of follow-up (November 15, 1998) involving 8800 men and women ≥30 years of age randomly selected throughout Japan, who participated in the National Survey on Circulatory Disorders in 1980. Resting HR was determined from 3 consecutive intervals between R waves on the 12-lead electrocardiogram.

Results

For middle-aged men (30 to 59 years of age), in the highest quartile of HR, there was a significant positive association with cardiovascular (RR, 2.55; 95% CI, 1.22 to 5.31) and all-cause death (RR, 1.45; 95% CI, 1.06 to 2.00). For middle-aged women, in the highest quartile, there was a significant positive association with noncancer, noncardiovascular (RR, 2.41; 95% CI, 1.04 to 5.59), and all-cause death (RR, 1.94; 95% CI, 1.26 to 3.01). Resting HR also showed a significant positive association with cardiac events but not to stroke. These relations were not evident for elderly subjects (≥60 years of age). Results were not affected when deaths within the first 5 years of follow-up were excluded, except for noncancer, noncardiovascular death.

Conclusions

High resting HR is an independent predictor of long-term death in the Japanese general population.

Section snippets

Populations

A total of 10,546 community dwellers (4640 men and 5906 women), ≥30 years of age in 300 randomly selected districts, participated in the survey; they were followed until November 15 in 1998. The current study extended the follow-up period of NIPPONDATA80 study, the details of which have previously been reported.12, 13, 14 Of the 10,546 participants, 1746 were excluded for the following reasons: past history of coronary heart disease or stroke (n = 280), missing information at baseline survey (n

Results

Table Ishows age-adjusted means or prevalences in the baseline characteristics of all participants by quartile of resting HR. There were significant differences in mean values for systolic blood pressure, diastolic blood pressure, pulse pressure, and serum glucose; they were higher in higher HR quartiles in both sexes. Mean values of BMI for men and albumin for women were also higher in higher quartiles of resting HR. Prevalence of antihypertensive agents users for women was lower in higher

Discussion

To our knowledge, few previous studies have examined the relation between resting HR and long-term death in Japanese living in Japan22, 23 (and Naito Y, et al, abstract in the Third International Conference of Preventive Cardiology, Oslo, 1993). However, these prior studies did not include age-specific analysis and were only limited to men. As in Western populations, higher HR was an independent predictor of all-cause death for middle-aged men and women in Japan. Resting HR also showed a

Acknowledgements

We thank Misao Ohara, Department of Health Science, Shiga University of Medical Science, for excellent clerical support in this research.

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Elevated resting heart rate (RHR) is a predictor of incident type 2 diabetes (T2D). Insulin resistance is thought to play a role in this association; however, the extent to which insulin resistance mediates this association is unclear.
1309 Japanese individuals without diabetes were recruited during 2009–2012 and followed for 5 years, of whom 78 developed T2D, as diagnosed by the 75 g oral glucose tolerance test. Supine RHR was measured by electrocardiography. Using logistic regression analysis, we examined the association between RHR and incident T2D, and interaction with the homeostasis model assessment of insulin resistance (HOMA-IR) index. Causal mediation analysis was applied to decompose the effect of RHR on the outcome and estimate the proportion mediated by the HOMA-IR index.
The sex- and age-adjusted cumulative incidence rate of T2D increased with increasing RHR. After adjustment for sex, age, waist circumference, current smoking status, alcohol use, habitual exercise, and cardiovascular disease medications, individuals with a RHR ≥80 bpm, compared with <60 bpm, showed an increased risk of incident T2D [odds ratio (OR), 2.89; 95 % confidence interval (CI), 1.07 to 7.80]. Multivariate adjusted OR for the total effect per 1 SD increase in RHR on incident T2D was 1.37 (95 % CI, 1.01 to 1.74) in the mediation analysis, and the proportion of the total indirect effect mediated by the HOMA-IR index was 27.5 % (95 % CI, 1.5 to 53.5).
Approximately 30 % of the effect of RHR on incident T2D was explained by the indirect effect of insulin resistance.
Independent and combined effects of resting heart rate and pulse pressure with metabolic syndrome in Chinese rural population: The Henan Rural Cohort study
2018, Clinica Chimica Acta
We examined the independent and cumulative associations of resting heart rate and pulse pressure with metabolic syndrome in Chinese rural population based on epidemiological research.
A total of 38,708 participants were derived from the Henan Rural Cohort study. Restricted cubic splines and logistic regression model were used to estimate the odds ratios and 95% confidence intervals of metabolic syndrome risk in relation to resting heart rate and pulse pressure.
After adjusting for potential confounders, the odds ratio (95% confidence intervals) of resting heart rate and pulse pressure in the highest quartile with the risk of metabolic syndrome were 1.59 (1.48–1.70) and1.81 (1.67–1.95), respectively. Simultaneously, the cumulative effect analysis indicated that the adjusted the odd ratio of resting heart rate and pulse pressure in the highest quartile was 2.89 (2.40–3.47). Furthermore, there was a significantly additive interaction between resting heart rate and pulse pressure on the risk of metabolic syndrome.
Increased resting heart rate and pulse pressure are associated with the higher risk of metabolic syndrome as well as the influences of resting heart rate with pulse pressure might cumulatively increase the risk of metabolic syndrome. However, the potential clinical application remains to be determined.
Association of Cumulative Exposure to Resting Heart Rate with Risk of Stroke in General Population: The Kailuan Cohort Study
2017, Journal of Stroke and Cerebrovascular Diseases
It remains unclear whether resting heart rate (RHR), particularly cumulative exposure to resting heart rate (cumRHR), is associated with stroke. The aim of our study was to prospectively explore the relationship between cumRHR and stroke morbidity.
The Kailuan study is a prospective longitudinal cohort study on cerebrovascular events and cardiovascular factors. Hazard ratios (HRs) with 95% confidence interval (CI) were calculated using a Cox competing risk model.
A total of 46,568 participants were included in the final analysis. In the observation population, we identified 851 stroke events and 1012 incident death cases in the 4.98 ± .51 year followed-up. Each 46.74 (beats/min) × year increase in heart rate was associated with a 12% increase in the risk of stroke (HR = 1.12, 95% CI = 1.05-1.20). In the categorical model, the highest quartile had an increased risk of stroke (HR = 1.43, 95% CI = 1.13-1.81), compared with the bottom quartile. Gender and age had no interaction with cumRHR for the risk of stroke.
Increase of exposure to cumulative heart rate is independently associated with a higher risk of stroke in the general population.
Resting Heart Rate Percentiles and Associated Factors in Children and Adolescents
2017, Journal of Pediatrics
To present population-based resting heart rate (RHR) percentiles and associated factors in children and adolescents.
Standardized RHR measurements with an oscillometric device were obtained from 3- to 17-year-olds who participated in the German Health Interview and Examination Survey for Children and Adolescents (n = 11 986). Age- and sex-specific RHR percentiles were derived using flexible age-dependent modeling. Linear regression was used to test associations of RHR and associated factors.
RHR decreased with age and mean RHR was on average 3.0 beats per minute (bpm) higher in girls than in boys (P < .01). The 95th RHR-KiGGS-percentile (P95) in boys and girls are up to 10 bpm lower than P95 based on pooled heterogeneous international studies and more similar to percentiles based on population data from NHANES (higher or lower by ≤5 bpm, depending on age). Factors independently associated with RHR in both sexes were age, SBP and height in children aged 3-10 years; and age, systolic blood pressure, and high aerobic fitness in adolescents aged 11-17 years. In girls, we further found an association between RHR and underweight (OR 3.3 and 4.7 for underweight girls aged 3-10 and 11-17, respectively, compared with normal weight girls). Associations between RHR and aerobic fitness, physical activity, and media use were stronger in boys than in girls.
This study provides population-based RHR percentiles and evidence for sex-dependent associations of cardiovascular risk factors with RHR in children and adolescents, many of which are lifestyle related.
Resting heart rate and the risk of cardiovascular disease, total cancer, and all-cause mortality – A systematic review and dose–response meta-analysis of prospective studies
2017, Nutrition, Metabolism and Cardiovascular Diseases
Citation Excerpt :
Although the test for nonlinearity was significant, pnonlinearity < 0.0001, the association was approximately linear (Fig. 6b, Supplementary Table 10). Fifty nine prospective studies (48 risk estimates, 48 publications) [3,7,9–13,16,17,19,20,28,31,32,36–38,40–43,46–49,53–56,59,61–68,70–73,78,80,98,100–102] were included in the analysis of resting heart rate and all-cause mortality and included >134,183 deaths among 1,810,695 participants (Supplementary Table 9). The summary RR for a 10 beat per minute increase in resting heart rate was 1.17 (95% CI: 1.14–1.19, I2 = 94.0%, pheterogeneity < 0.0001) for all-cause mortality (Fig. 7a).
Epidemiological studies have reported increased risk of cardiovascular disease, cancer and all-cause mortality with greater resting heart rate, however, the evidence is not consistent. Differences by gender, adjustment for confounding factors, as well as the potential impact of subclinical disease are not clear. A previous meta-analysis missed a large number of studies, and data for atrial fibrillation have not been summarized before. We therefore aimed to clarify these associations in a systematic review and meta-analysis of prospective studies.
PubMed and Embase were searched up to 29 March 2017. Summary RRs and 95% confidence intervals (CIs) were calculated using random effects models. Eighty seven studies were included. The summary RR per 10 beats per minute increase in resting heart rate was 1.07 (95% CI: 1.05–1.10, I² = 61.9%, n = 31) for coronary heart disease, 1.09 (95% CI: 1.00–1.18, I² = 62.3%, n = 5) for sudden cardiac death, 1.18 (95% CI: 1.10–1.27, I² = 74.5%, n = 8) for heart failure, 0.97 (95% CI: 0.92–1.02, I² = 91.4%, n = 9) for atrial fibrillation, 1.06 (95% CI: 1.02–1.10, I² = 59.5%, n = 16) for total stroke, 1.15 (95% CI: 1.11–1.18, I² = 84.3%, n = 35) for cardiovascular disease, 1.14 (95% CI: 1.06–1.23, I² = 90.2%, n = 12) for total cancer, and 1.17 (95% CI: 1.14–1.19, I² = 94.0%, n = 48) for all-cause mortality. There was a positive dose–response relationship for all outcomes except for atrial fibrillation for which there was a J-shaped association.
This meta-analysis found an increased risk of coronary heart disease, sudden cardiac death, heart failure, atrial fibrillation, stroke, cardiovascular disease, total cancer and all-cause mortality with greater resting heart rate.
Association of resting heart rate and cardiovascular disease mortality in hypertensive and normotensive rural Chinese
2017, Journal of Cardiology
Studies have demonstrated an increased risk of cardiovascular disease (CVD)-associated death (CVD death) with increased resting heart rate (RHR); however, whether the association is consistent in rural Chinese with hypertension and normotension is unknown. We examined the association of RHR and CVD death by hypertension and normotension status in rural Chinese people.
Baseline data for 20,069 participants ≥18 years old were collected during July to August of 2007 and July to August of 2008; 17,151 (85.5%) participants were followed up in July to August of 2013 and July to October of 2014. The association of RHR and CVD death was determined by Cox proportional hazards regression.
During a mean of 5.88 years (100,889 person-years) of follow-up, we recorded 479 CVD deaths (309 in hypertensive participants). CVD death increased significantly with increasing RHR, beginning from 80 beats per minute (bpm), for hypertensive and normotensive participants. After adjusting for pulse pressure and other covariates, for hypertensive participants, risk of CVD death was increased with RHR 80–89 and ≥90 bpm. However, for normotensive participants, risk of CVD death was increased with only RHR ≥ 90 bpm.
Risk of CVD death was associated with elevated RHR for both hypertensive and normotensive rural Chinese, and for hypertensive participants, even slightly elevated RHR was associated with CVD death.

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^☆: Supported by the Research Grant for Cardiovascular Diseases (7A-2) from the ministry of Health and Welfare, Japan, and a Health and Labor Sciences Research Grant from the Ministry of Health, Labor and Welfare, Japan (Comprehensive Research on Aging and Health: H11-Chouju-046, H14-Chouju-003).

^†: Investigators and members of the research group are listed in 12, 13, 14.

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Clinical investigations: acute ischemic heart diseaseResting heart rate and cause-specific death in a 16.5-year cohort study of the Japanese general population☆

Abstract

Background

Methods

Results

Conclusions

Section snippets

Populations

Results

Discussion

Acknowledgements

Am Heart J

Am Heart J

J Clin Epidemiol

J Clin Epidemiol

J Auton Nerv Syst

Am Heart J

J Clin Epidemiol

Lancet

Am Heart J

Heart rate as a prognostic factor for coronary heart disease and mortalityfindings in three Chicago epidemiologic studies

Am J Epidemiol

Heart rate, ischaemic heart disease, and sudden cardiac death in middle-aged British men

Br Heart J

The relation between heart rate and all-cause, cardiovascular and cancer mortality

Eur Heart J

Influence of heart rate on mortality in a French Populationrole of age, gender and blood pressure

Hypertension

High heart ratea risk factor for cardiovascular death in elderly men

Arch Intern Med

Resting heart rate is a risk factor for cardiovascular and noncardiovascular mortalitythe Chicago Heart Association Detection Project Industry

Am J Epidemiol

Heart rate as a predictor of mortalitythe MATISS project

Am J Public Health

Rapid resting heart ratea simple and powerful predictor of osteoporotic fractures and mortality in older women

J Am Geriatr Soc

Nutrient intakes of middle-aged men and women in China, Japan, United Kingdom, and United States in the late 1990sthe INTERMAP study

J Hum Hypertens

Prevalence of impaired activities of daily living and impact of stroke and lower limb fracture on it in Japanese elderly people

CVD prevention

Absence of an association between serum uric acid and mortality from cardiovascular diseaseNIPPON DATA 80, 1980–1994. National Integrated Projects for Prospective Observation of Non-communicable Diseases and its Trend in the Aged

Eur J Epidemiol

What cause of mortality can we predict by cholesterol screening in the Japanese general population?

J Intern Med

Clinical investigations: acute ischemic heart disease
Resting heart rate and cause-specific death in a 16.5-year cohort study of the Japanese general population☆