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Long-term cardiovascular risks associated with an elevated heart rate: the Framingham Heart Study
Jennifer E Ho1, Martin G Larson, Anahita Ghorbani
1Framingham Heart Study of the National Heart, Lung and Blood Institute, Boston University School of Medicine, Framingham, MA.
Insights
Higher resting heart rate increases the long-term risk of cardiovascular disease and death. However, elevated heart rate may reduce the need for a permanent pacemaker.
Area of Science:
- Cardiology
- Preventive Medicine
- Epidemiology
Background:
- Resting heart rate is a predictor of cardiovascular prognosis, but prior research has limitations.
- Previous studies often focused on patients with existing cardiovascular disease or a narrow range of outcomes.
Purpose of the Study:
- To investigate the association between baseline heart rate and both fatal and nonfatal health outcomes.
- To analyze long-term risks associated with varying heart rates over two decades.
Main Methods:
- Analysis of data from 4058 participants in the Framingham Heart Study.
- Utilized Cox regression models with adjustments for clinical risk factors and physical activity.
Main Results:
- Higher baseline heart rate correlated with increased risk of incident cardiovascular disease (HR 1.15), particularly heart failure (HR 1.32).
- Elevated heart rate was linked to higher all-cause mortality (HR 1.17) and cardiovascular mortality (HR 1.18).
- Conversely, higher heart rate was associated with a reduced risk of requiring a permanent pacemaker (HR 0.55).
Conclusions:
- Elevated resting heart rate signifies an increased long-term risk for cardiovascular events, especially heart failure, and overall mortality.
- A higher heart rate is paradoxically associated with a decreased likelihood of needing a permanent pacemaker.
Background:
Higher heart rate has been associated with an adverse prognosis, but most prior studies focused on individuals with known cardiovascular disease or examined a limited number of outcomes. We sought to examine the association of baseline heart rate with both fatal and nonfatal outcomes during 2 decades of follow-up.
Methods And Results:
Our study included 4058 Framingham Heart Study participants (mean age 55 years, 56% women). Cox models were performed with multivariable adjustment for clinical risk factors and physical activity. A total of 708 participants developed incident cardiovascular disease (303 heart failure, 343 coronary heart disease, and 216 stroke events), 48 received a permanent pacemaker, and 1186 died. Baseline heart rate was associated with incident cardiovascular disease (hazard ratio [HR] 1.15 per 1 SD [11 bpm] increase in heart rate, 95% CI 1.07 to 1.24, P=0.0002), particularly heart failure (HR 1.32, 95% CI 1.18 to 1.48, P<0.0001). Higher heart rate was also associated with higher all-cause (HR 1.17, 95% CI 1.11 to 1.24, P<0.0001) and cardiovascular mortality (HR 1.18, 95% CI 1.04 to 1.33, P=0.01). Spline analyses did not suggest a lower threshold beyond which the benefit of a lower heart rate abated or increased. In contrast, individuals with a higher heart rate had a lower risk of requiring permanent pacemaker placement (HR 0.55, 95% CI 0.38 to 0.79, P=0.001).
Conclusions:
Individuals with a higher heart rate are at elevated long-term risk for cardiovascular events, in particular, heart failure, and all-cause death. On the other hand, a higher heart rate is associated with a lower risk of future permanent pacemaker implantation.