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Heart rate and ischemic stroke: the REasons for Geographic And Racial Differences in Stroke (REGARDS) study
Wesley T O'Neal1, Waqas T Qureshi2, Suzanne E Judd3
1Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.
Insights
Higher resting heart rates are linked to increased ischemic stroke risk. This study found that elevated heart rates, even within normal ranges, correlate with a greater chance of experiencing a stroke.
Area of Science:
- Cardiovascular epidemiology
- Neurology
- Clinical research
Background:
- The relationship between resting heart rate and ischemic stroke risk is not well-established.
- Understanding this association is crucial for stroke prevention strategies.
Purpose of the Study:
- To investigate the association between resting heart rate and the incidence of ischemic stroke.
- To determine if higher resting heart rates predict a greater risk of stroke.
Main Methods:
- Analysis of 24,730 participants from the REasons for Geographic And Racial Differences in Stroke (REGARDS) study, free of stroke at baseline.
- Resting heart rate assessed via electrocardiogram and analyzed as a continuous and categorical variable (tertiles).
- Follow-up for first-time ischemic stroke events, adjudicated by physician review over a median of 7.6 years.
Main Results:
- Each 10 bpm increase in resting heart rate was associated with a 10% increased risk of ischemic stroke (HR=1.10).
- Elevated stroke risk observed in the middle (HR=1.29) and upper (HR=1.37) resting heart rate tertiles compared to the lowest.
- Findings remained consistent across various demographic and clinical subgroups.
Conclusions:
- High resting heart rates are significantly associated with an increased risk of ischemic stroke.
- Further research is warranted to explore heart rate-lowering interventions for stroke risk reduction.
Background:
The association between resting heart rate and ischemic stroke remains unclear.
Aim:
To examine the association between resting heart rate and ischemic stroke.
Methods:
A total of 24 730 participants (mean age: 64 ± 9·3 years; 59% women; 41% blacks) from the REasons for Geographic And Racial Differences in Stroke (REGARDS) study who were free of stroke at the time of enrollment (2003-2007) were included in this analysis. Resting heart rate was determined from baseline electrocardiogram data. Heart rate was examined as a continuous variable per 10 bpm increase and also as a categorical variable using tertiles ( <61 bpm, 61 to 70 bpm, and >70 bpm). First-time ischemic stroke events were identified during follow-up and adjudicated by physician review.
Results:
Over a median follow-up of 7·6 years, a total of 646 ischemic strokes occurred. In a Cox regression model adjusted for socio-demographics, cardiovascular risk factors, and potential confounders, each 10 bpm increase in heart rate was associated with a 10% increase in the risk of ischemic stroke (hazard ratio = 1·10, 95% confidence interval = 1·02, 1·18). In the categorical model, an increased risk of ischemic stroke was observed for heart rates in the middle (hazard ratio = 1·29, 95% confidence interval = 1·06, 1·57) and upper (hazard ratio = 1·37, 95% confidence interval = 1·12, 1·67) tertiles compared with the lower tertile. The results were consistent when the analysis was stratified by age, gender, race, exercise habits, hypertension, and coronary heart disease.
Conclusion:
In REGARDS, high resting heart rates were associated with an increased risk of ischemic stroke compared with low heart rates. Further research is needed to examine whether interventions aimed to reduce heart rate decrease stroke risk.
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