Pooled results on resting heart rate and risk of cardiovascular 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 | 13 | 1.24 (1.12–1.38) | 39.8 | 13 | 1.70 (1.48–1.94) | 40.2 | 26 | 1.42 (1.29–1.57) | 56.9 | |||
| Multivariate-adjusted | 19 | 1.08 (0.99–1.17) | 55.8 | 22 | 1.33 (1.19–1.47) | 61.0 | 32 | 1.08 (1.06–1.10) | 81.0 | |||
| Excluding deaths during the first 1–5 yr | 11 | 1.09 (1.05–1.12) | 67.1 | |||||||||
| Among those not taking heart rate–lowering medication | 9 | 1.13 (1.07–1.19) | 79.0 | |||||||||
| Among studies adjusting for heart rate–lowering medication | 7 | 1.15 (1.04–1.26) | 88.0 | |||||||||
| Follow-up duration, yr | 0.6 | 0.1 | 0.08 | |||||||||
| > 10 | 12 | 1.06 (0.96–1.18) | 60.4 | 15 | 1.26 (1.11–1.44) | 68.3 | 26 | 1.06 (1.04–1.08) | 75.4 | |||
| ≤ 10 | 7 | 1.11 (0.96–1.29) | 50.6 | 7 | 1.49 (1.34–1.65) | 0.00 | 6 | 1.16 (1.05–1.28) | 87.1 | |||
| Sample size | 0.2 | 0.6 | 0.4 | |||||||||
| > 10 000 | 5 | 1.00 (0.88–1.14) | 67.3 | 7 | 1.28 (1.04–1.57) | 80.5 | 12 | 1.10 (1.06–1.14) | 90.5 | |||
| ≤ 10 000 | 14 | 1.12 (1.01–1.24) | 47.6 | 15 | 1.35 (1.20–1.53) | 39.6 | 20 | 1.06 (1.03–1.09) | 59.3 | |||
| Mean age, yr | 0.5 | 0.2 | 0.6 | |||||||||
| > 50 | 9 | 1.11 (0.99–1.24) | 46.2 | 10 | 1.44 (1.31–1.57) | 0.00 | 17 | 1.10 (1.05–1.14) | 80.3 | |||
| ≤ 50 | 10 | 1.05 (0.93–1.18) | 64.4 | 12 | 1.25 (1.06–1.46) | 73.3 | 15 | 1.07 (1.04–1.11) | 82.7 | |||
| Region | 0.5 | 0.6 | 0.05 | |||||||||
| Europe | 10 | 1.10 (0.92–1.31) | 72.1 | 12 | 1.28 (1.04–1.58) | 75.9 | 18 | 1.07 (1.04–1.09) | 77.3 | |||
| United States | 4 | 1.03 (0.94–1.12) | 0.00 | 6 | 1.42 (1.27–1.58) | 0.00 | 7 | 1.05 (1.00–1.11) | 70.8 | |||
| Asia | 4 | 1.02 (0.88–1.19) | 34.6 | 3 | 1.25 (1.02–1.52) | 0.00 | 5 | 1.11 (1.02–1.21) | 40.9 | |||
| Mixed | 1 | 1.08 (0.99–1.18) | – | 1 | 1.45 (1.28–1.64) | – | 2 | 1.27 (1.00–1.60) | 89.4 | |||
| Australia | 0.2 | 0.3 | 0.1 | |||||||||
| Excluding CVD at baseline | 14 | 1.04 (0.94–1.15) | 59.9 | 14 | 1.26 (1.09–1.46) | 66.3 | 21 | 1.06 (1.04–1.08) | 78.3 | |||
| Yes | 5 | 1.20 (1.02–1.41) | 36.5 | 8 | 1.44 (1.26–1.64) | 34.6 | 11 | 1.14 (1.06–1.21) | 81.4 | |||
| No | 0.2 | 0.6 | 0.4 | |||||||||
| Sex | 9 | 1.15 (0.99–1.34) | 67.3 | 11 | 1.44 (1.26–1.64) | 50.1 | 14 | 1.08 (1.04–1.12) | 73.1 | |||
| Male | 5 | 0.98 (0.82–1.18) | 42.1 | 6 | 1.04 (0.85–1.29) | 57.4 | 9 | 1.03 (1.00–1.07) | 26.2 | |||
| Female | 5 | 1.04 (0.94–1.15) | 35.3 | 5 | 1.46 (1.32–1.62) | 0.00 | 9 | 1.12 (1.07–1.17) | 92.0 | |||
| Both sexes | 0.5 | > 0.9 | 0.02 | |||||||||
| Resting heart rate assessment | 10 | 1.10 (1.00–1.22) | 27.5 | 10 | 1.32 (1.15–1.52) | 42.2 | 19 | 1.05 (1.03–1.08) | 75.5 | |||
| Electrocardiogram | 9 | 1.04 (0.91–1.19) | 71.6 | 12 | 1.33 (1.13–1.56) | 71.2 | 13 | 1.14 (1.08–1.21) | 86.2 | |||
| Others | 0.6 | 0.2 | 0.7 | |||||||||
| Resting period | 10 | 1.10 (0.97–1.24) | 55.0 | 11 | 1.43 (1.29–1.58) | 12.0 | 18 | 1.08 (1.04–1.11) | 70.4 | |||
| ≥ 5 min | 9 | 1.05 (0.94–1.19) | 61.3 | 11 | 1.23 (1.04–1.47) | 74.4 | 14 | 1.09 (1.05–1.13) | 87.6 | |||
| < 5 min or unclear | 0.5 | 0.4 | 0.7 | |||||||||
| Posture | 8 | 1.11 (0.95–1.30) | 58.8 | 9 | 1.40 (1.24–1.59) | 22.0 | 11 | 1.09 (1.04–1.13) | 56.9 | |||
| Supine | 11 | 1.05 (0.96–1.16) | 55.0 | 13 | 1.28 (1.10–1.49) | 71.8 | 21 | 1.07 (1.05–1.10) | 81.7 | |||
| Sitting/ recumbent/unclear | 0.2 | 0.05 | 0.1 | |||||||||
| Study quality* | 13 | 1.04 (0.97–1.11) | 26.5 | 15 | 1.24 (1.10–1.40) | 61.6 | 27 | 1.06 (1.04–1.09) | 76.0 | |||
| 7–9 | 6 | 1.15 (0.89–1.47) | 74.9 | 7 | 1.58 (1.37–1.83) | 15.2 | 5 | 1.14 (1.03–1.26) | 88.6 | |||
| 5–6 | ||||||||||||
| Adjusted for ... | 0.1 | 0.4 | 0.7 | |||||||||
| Blood pressure | 17 | 1.06 (0.98–1.13) | 40.8 | 18 | 1.29 (1.15–1.45) | 59.1 | 31 | 1.08 (1.06–1.10) | 81.6 | |||
| Yes | 2 | 0.98 (0.36–2.67) | 79.7 | 4 | 1.47 (1.10–1.98) | 70.9 | 1 | 1.05 (0.98–1.12) | 0.00 | |||
| No | – | – | 0.7 | |||||||||
| Smoking | 19 | 1.08 (0.99–1.17) | 55.8 | 22 | 1.33 (1.19–1.47) | 61.0 | 31 | 1.07 (1.05–1.10) | 78.3 | |||
| Yes | – | – | – | – | – | – | 1 | 1.12 (1.09–1.16) | 0.00 | |||
| No | > 0.9 | 0.9 | > 0.9 | |||||||||
| Body mass index | 12 | 1.07 (0.98–1.18) | 43.7 | 15 | 1.33 (1.20–1.48) | 39.3 | 27 | 1.08 (1.05–1.10) | 82.1 | |||
| Yes | 7 | 1.07 (0.90–1.26) | 71.5 | 7 | 1.32 (1.03–1.70) | 80.2 | 5 | 1.08 (1.03–1.14) | 57.0 | |||
| No | 0.2 | 0.04 | 0.02 | |||||||||
| Physical activity | 9 | 1.02 (0.91–1.14) | 48.4 | 11 | 1.18 (0.99–1.41) | 68.2 | 12 | 1.04 (1.02–1.06) | 80.1 | |||
| Yes | 10 | 1.13 (1.01–1.28) | 58.7 | 11 | 1.46 (1.33–1.60) | 17.1 | 20 | 1.13 (1.08–1.18) | 70.1 | |||
| No | 0.4 | 0.6 | – | |||||||||
| Serum cholesterol/triglycerides | 17 | 1.06 (0.98–1.15) | 41.9 | 18 | 1.30 (1.15–1.47) | 58.9 | 32 | 1.08 (1.06–1.10) | 81.0 | |||
| Yes | 2 | 1.18 (0.74–1.88) | 91.5 | 4 | 1.42 (1.11–1.81) | 74.7 | – | – | – | |||
| No | 0.3 | 0.3 | 0.7 | |||||||||
| Diabetes/blood glucose | 12 | 1.04 (0.95–1.14) | 48.4 | 13 | 1.26 (1.09–1.47) | 67.9 | 25 | 1.09 (1.06–1.12) | 83.4 | |||
| Yes | 7 | 1.14 (0.96–1.35) | 63.9 | 9 | 1.43 (1.23–1.66) | 44.9 | 7 | 1.06 (1.02–1.10) | 66.9 | |||
| No | 0.8 | 0.6 | 0.7 | |||||||||
| Alcohol | 3 | 1.02 (0.93–1.12) | 0.00 | 6 | 1.40 (1.21–1.61) | 22.0 | 11 | 1.07 (1.04–1.10) | 79.1 | |||
| Yes | 16 | 1.08 (0.98–1.19) | 61.0 | 16 | 1.30 (1.13–1.49) | 67.8 | 21 | 1.09 (1.05–1.13) | 82.2 | |||
| No | 0.6 | 0.3 | 0.1 | |||||||||
| Education/socioeconomic status | 6 | 1.04 (0.93–1.17) | 6.70 | 8 | 1.24 (1.10–1.39) | 38.3 | 10 | 1.04 (1.02–1.07) | 71.9 | |||
| Yes | 13 | 1.09 (0.98–1.21) | 65.8 | 14 | 1.41 (1.20–1.66) | 66.4 | 22 | 1.11 (1.07–1.15) | 82.8 | |||
| No | 0.9 | 0.6 | 0.1 | |||||||||
| No. covariates adjusted | ||||||||||||
| ≥ 6 | 5 | 1.05 (0.97–1.14) | 0.00 | 6 | 1.26 (1.04–1.53) | 45.9 | 17 | 1.05 (1.03–1.07) | 75.8 | |||
| < 6 | 14 | 1.07 (0.95–1.20) | 65.5 | 16 | 1.35 (1.19–1.53) | 65.6 | 15 | 1.17 (1.07–1.17) | 78.5 | |||
Note: CI = confidence interval, CVD = cardiovascular disease, RR = relative risk.
↵* Study quality was judged based on the Newcastle–Ottawa Scale (range 1–9 stars).