Pooled results on resting heart rate and risk of all-cause mortality
| Variable | 60–80 beats/min | > 80 beats/min | 10 beats/min increment | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| No. | RR (95% CI) | I2 value, % | p value | No. | RR (95% CI) | I2 value, % | p value | No. | RR (95% CI) | I2 value, % | p value | |
| Age-adjusted | 16 | 1.21 (1.14–1.29) | 65.4 | 17 | 1.66 (1.48–1.87) | 83.9 | 20 | 1.14 (1.09–1.18) | 97.5 | |||
| Multivariate-adjusted | 25 | 1.12 (1.07–1.17) | 66.7 | 32 | 1.45 (1.34–1.57) | 81.3 | 35 | 1.09 (1.07–1.12) | 92.3 | |||
| Excluding deaths during the first 6 mo to 5 yr | 12 | 1.09 (1.06–1.13) | 85.9 | |||||||||
| Among those not taking heart rate–lowering medication | 12 | 1.11 (1.06–1.16) | 95.3 | |||||||||
| Among studies adjusting for heart rate–lowering medication | 8 | 1.13 (1.07–1.19) | 94.4 | |||||||||
| Follow-up duration | 0.5 | 0.01 | 0.08 | |||||||||
| > 10 yr | 15 | 1.11 (1.04–1.18) | 76.0 | 18 | 1.34 (1.22–1.48) | 82.5 | 27 | 1.08 (1.06–1.10) | 90.5 | |||
| ≤ 10 yr | 10 | 1.14 (1.08–1.20) | 0.00 | 14 | 1.64 (1.51–1.78) | 40.7 | 8 | 1.14 (1.07–1.22) | 93.4 | |||
| Sample size | 0.1 | 0.8 | 0.8 | |||||||||
| > 10 000 | 10 | 1.07 (1.02–1.13) | 67.2 | 12 | 1.43 (1.30–1.57) | 83.4 | 15 | 1.10 (1.06–1.14) | 96.0 | |||
| ≤ 10 000 | 15 | 1.17 (1.08–1.27) | 55.0 | 20 | 1.48 (1.29–1.70) | 80.3 | 20 | 1.08 (1.06–1.10) | 78.3 | |||
| Mean age, yr | 0.3 | 0.8 | 0.03 | |||||||||
| > 50 | 16 | 1.15 (1.08–1.22) | 59.5 | 19 | 1.46 (1.33–1.60) | 73.8 | 18 | 1.13 (1.09–1.17) | 90.6 | |||
| ≤ 50 | 9 | 1.08 (1.00–1.16) | 72.5 | 13 | 1.44 (1.24–1.66) | 87.5 | 17 | 1.07 (1.04–1.09) | 92.2 | |||
| Region | 0.2 | 0.5 | 0.04 | |||||||||
| Europe | 14 | 1.18 (1.10–1.27) | 55.2 | 17 | 1.52 (1.33–1.74) | 83.3 | 18 | 1.09 (1.06–1.11) | 87.7 | |||
| United States | 7 | 1.04 (0.99–1.10) | 59.1 | 9 | 1.39 (1.22–1.57) | 80.2 | 9 | 1.05 (1.03–1.08) | 85.8 | |||
| Asia | 3 | 1.05 (0.84–1.30) | 70.6 | 4 | 1.35 (1.11–1.64) | 70.3 | 6 | 1.13 (1.07–1.19) | 62.5 | |||
| Mixed | 1 | 1.17 (1.04–1.31) | – | 1 | 1.54 (1.43–1.66) | – | 2 | 1.25 (1.01–1.56) | 95.2 | |||
| Australia | – | – | – | 1 | 1.19 (0.45–3.16) | – | ||||||
| Excluding CVD at baseline | 0.2 | 0.07 | 0.6 | |||||||||
| Yes | 16 | 1.10 (1.03–1.16) | 72.9 | 18 | 1.36 (1.24–1.50) | 82.8 | 23 | 1.09 (1.06–1.12) | 92.2 | |||
| No | 9 | 1.15 (1.09–1.21) | 0.00 | 14 | 1.60 (1.42–1.80) | 70.3 | 12 | 1.11 (1.07–1.15) | 92.0 | |||
| Sex | 0.9 | > 0.9 | 0.1 | |||||||||
| Male | 12 | 1.13 (1.06–1.21) | 68.6 | 14 | 1.47 (1.27–1.71) | 89.0 | 14 | 1.08 (1.05–1.11) | 91.6 | |||
| Female | 4 | 1.06 (0.96–1.19) | 26.7 | 7 | 1.39 (1.18–1.65) | 59.7 | 9 | 1.07 (1.04–1.10) | 76.5 | |||
| Both sexes | 9 | 1.13 (1.03–1.24) | 73.5 | 11 | 1.44 (1.31–1.59) | 68.0 | 12 | 1.14 (1.08–1.20) | 95.6 | |||
| Resting heart rate assessment | > 0.9 | 0.4 | 0.01 | |||||||||
| Electrocardiogram | 12 | 1.13 (1.04–1.22) | 70.1 | 17 | 1.52 (1.35–1.70) | 79.2 | 23 | 1.06 (1.04–1.08) | 89.0 | |||
| Others | 13 | 1.12 (1.05–1.19) | 64.7 | 15 | 1.40 (1.25–1.56) | 84.1 | 12 | 1.15 (1.10–1.20) | 89.6 | |||
| Minimum of resting period | > 0.9 | 0.2 | 0.9 | |||||||||
| ≥ 5 min | 8 | 1.13 (0.99–1.29) | 80.8 | 13 | 1.60 (1.38–1.85) | 82.0 | 19 | 1.09 (1.06–1.12) | 89.5 | |||
| < 5 min or unclear | 17 | 1.11 (1.06–1.16) | 54.7 | 19 | 1.39 (1.27–1.51) | 75.5 | 16 | 1.10 (1.06–1.14) | 94.5 | |||
| Posture | 0.2 | 0.2 | 0.8 | |||||||||
| Supine | 9 | 1.19 (1.06–1.35) | 78.7 | 15 | 1.56 (1.32–1.84) | 86.8 | 13 | 1.09 (1.05–1.13) | 92.8 | |||
| Sitting/ recumbent/unclear | 16 | 1.09 (1.04–1.14) | 52.0 | 17 | 1.36 (1.26–1.47) | 70.8 | 22 | 1.10 (1.07–1.12) | 92.2 | |||
| Study quality* | 0.05 | 0.01 | 0.4 | |||||||||
| 7–9 | 16 | 1.08 (1.03–1.14) | 66.8 | 18 | 1.33 (1.24–1.44) | 73.2 | 28 | 1.09 (1.06–1.11) | 91.3 | |||
| 5–6 | 9 | 1.22 (1.14–1.31) | 8.60 | 14 | 1.67 (1.45–1.92) | 76.0 | 7 | 1.12 (1.05–1.20) | 93.8 | |||
| Adjusted for ... | ||||||||||||
| Blood pressure | 0.1 | 0.09 | 0.7 | |||||||||
| Yes | 23 | 1.11 (1.06–1.16) | 61.8 | 29 | 1.42 (1.32–1.53) | 78.8 | 34 | 1.10 (1.07–1.12) | 92.5 | |||
| No | 2 | 1.22 (0.85–1.75) | 61.0 | 3 | 1.97 (1.64–2.37) | 13.6 | 1 | 1.07 (1.02–1.12) | – | |||
| Smoking | – | 0.7 | 0.8 | |||||||||
| Yes | 25 | 1.12 (1.07–1.17) | 66.7 | 31 | 1.45 (1.34–1.57) | 81.9 | 32 | 1.09 (1.07–1.12) | 92.2 | |||
| No | 0 | – | – | 1 | 1.19 (0.45–3.18) | – | 1 | 1.11 (1.08–1.14) | – | |||
| Body mass index | 0.6 | 0.8 | 0.2 | |||||||||
| Yes | 19 | 1.13 (1.07–1.20) | 65.5 | 25 | 1.44 (1.32–1.57) | 78.6 | 29 | 1.09 (1.06–1.11) | 92.2 | |||
| No | 6 | 1.10 (1.09–1.20) | 74.6 | 7 | 1.49 (1.22–1.82) | 88.6 | 6 | 1.12 (1.08–1.15) | 57.2 | |||
| Physical activity | 0.5 | 0.3 | 0.3 | |||||||||
| Yes | 13 | 1.15 (1.06–1.24) | 70.9 | 17 | 1.52 (1.36–1.70) | 76.8 | 14 | 1.08 (1.05–1.10) | 93.4 | |||
| No | 12 | 1.10 (1.03–1.17) | 64.2 | 15 | 1.38 (1.23–1.55) | 85.3 | 21 | 1.11 (1.07–1.16) | 91.9 | |||
| Serum cholesterol/triglycerides | 0.4 | 0.5 | 0.9 | |||||||||
| Yes | 22 | 1.10 (1.06–1.15) | 59.1 | 26 | 1.43 (1.33–1.54) | 77.7 | 33 | 1.09 (1.07–1.11) | 92.6 | |||
| No | 3 | 1.21 (0.91–1.61) | 87.1 | 6 | 1.50 (1.04–2.17) | 88.5 | 2 | 1.10 (1.06–1.14) | 18.5 | |||
| Diabetes/blood glucose | 0.03 | 0.1 | 0.6 | |||||||||
| Yes | 15 | 1.06 (1.02–1.11) | 45.4 | 18 | 1.37 (1.25–1.50) | 80.7 | 27 | 1.10 (1.07–1.13) | 93.5 | |||
| No | 10 | 1.21 (1.09–1.34) | 65.5 | 14 | 1.58 (1.37–1.82) | 78.7 | 8 | 1.08 (1.05–1.10) | 75.4 | |||
| Alcohol | 0.5 | 0.9 | 0.6 | |||||||||
| Yes | 7 | 1.17 (1.04–1.31) | 81.0 | 9 | 1.44 (1.30–1.59) | 56.5 | 13 | 1.08 (1.04–1.13) | 90.9 | |||
| No | 18 | 1.10 (1.05–1.16) | 58.1 | 23 | 1.45 (1.31–1.61) | 85.1 | 22 | 1.10 (1.07–1.13) | 93.2 | |||
| Education/socioeconomic status | 0.3 | 0.4 | 0.3 | |||||||||
| Yes | 10 | 1.16 (1.06–1.27) | 57.8 | 10 | 1.37 (1.19–1.58) | 76.3 | 10 | 1.07 (1.03–1.11) | 87.4 | |||
| No | 15 | 1.10 (1.04–1.15) | 66.9 | 22 | 1.49 (1.36–1.64) | 82.3 | 25 | 1.10 (1.08–1.13) | 93.5 | |||
| No. covariates adjusted | 0.8 | 0.7 | 0.1 | |||||||||
| ≥ 6 | 10 | 1.13 (1.04–1.24) | 72.3 | 13 | 1.43 (1.26–1.61) | 80.7 | 17 | 1.07 (1.04–1.10) | 88.9 | |||
| < 6 | 15 | 1.11 (1.05–1.18) | 64.5 | 19 | 1.48 (1.33–1.64) | 82.6 | 18 | 1.12 (1.08–1.15) | 94.0 | |||
Note: CI = confidence interval, CVD = cardiovascular disease, RR = relative risk.
↵* Study quality was judged based on the Newcastle–Ottawa Scale (range 1–9 stars).