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Research

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

Dongfeng Zhang, Xiaoli Shen and Xin Qi
CMAJ February 16, 2016 188 (3) E53-E63; DOI: https://doi.org/10.1503/cmaj.150535
Dongfeng Zhang
Departments of Epidemiology and Health Statistics (Zhang, Shen), and Clinical Medicine (Qi), Medical College of Qingdao University, Shandong, China
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  • For correspondence: zhangdf1961@126.com
Xiaoli Shen
Departments of Epidemiology and Health Statistics (Zhang, Shen), and Clinical Medicine (Qi), Medical College of Qingdao University, Shandong, China
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Xin Qi
Departments of Epidemiology and Health Statistics (Zhang, Shen), and Clinical Medicine (Qi), Medical College of Qingdao University, Shandong, China
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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.

  • Accepted September 17, 2015.
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Canadian Medical Association Journal: 188 (3)
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Vol. 188, Issue 3
16 Feb 2016
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Resting heart rate and all-cause and cardiovascular mortality in the general population: a meta-analysis
Dongfeng Zhang, Xiaoli Shen, Xin Qi
CMAJ Feb 2016, 188 (3) E53-E63; DOI: 10.1503/cmaj.150535

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Resting heart rate and all-cause and cardiovascular mortality in the general population: a meta-analysis
Dongfeng Zhang, Xiaoli Shen, Xin Qi
CMAJ Feb 2016, 188 (3) E53-E63; DOI: 10.1503/cmaj.150535
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