Daily Heart Rate per Step: A Wearables Metric Associated With Cardiovascular Disease in a Cross-Sectional Study of
Zhanlin Chen1, Charles T Wang1, Carolyn J Hu1
1Feinberg School of Medicine Northwestern University Chicago IL USA.
Insights
Daily heart rate per step (DHRPS), a new wearable metric, shows stronger links to cardiovascular disease risk and fitness than traditional measures. This finding highlights DHRPS as a valuable tool for assessing cardiovascular health.
Area of Science:
- Cardiovascular disease research
- Wearable technology in health
- Biometric data analysis
Background:
- Cardiovascular disease (CVD) risk assessment traditionally relies on simple metrics like peak heart rate and exercise duration.
- Commercial wearable devices generate extensive longitudinal data on physical activity and cardiac electrical signals.
- This data offers a significant opportunity to discover novel CVD predictors.
Purpose of the Study:
- To introduce and evaluate daily heart rate per step (DHRPS) as a novel metric derived from wearable data.
- To assess the association of DHRPS with established cardiovascular disease (CVD) risk factors and outcomes.
- To compare the predictive power of DHRPS against traditional metrics like daily heart rate (DHR) and step count.
Main Methods:
- A cross-sectional analysis of 6947 participants from the Fitbit Bring-Your-Own-Device Project (All of Us Research Program).
- Calculation of DHRPS by dividing average daily heart rate by daily step count.
- Correlation of DHRPS with established CVD factors (e.g., type 2 diabetes, hypertension) and performance on exercise stress tests.
- Phenome-wide association study to explore DHRPS associations across a broad spectrum of disease traits.
Main Results:
- Elevated DHRPS was significantly associated with increased odds of type 2 diabetes, hypertension, heart failure, and coronary atherosclerosis.
- DHRPS demonstrated stronger correlations with maximal exercise capacity (maximum metabolic equivalents) compared to DHR or step count alone.
- A DHRPS-based phenome-wide association study revealed substantially stronger links to CVD factors than DHR or step count.
Conclusions:
- Daily heart rate per step (DHRPS) is an easily calculable metric from wearable devices.
- DHRPS exhibits a stronger association with cardiovascular fitness and CVD outcomes than daily heart rate or step count.
- DHRPS represents a promising new metric for evaluating cardiovascular health using wearable technology.
Background:
Simple biometrics such as peak heart rate and exercise duration remain core predictors of cardiovascular disease (CVD). Commercial wearable devices track physical and cardiac electrical activity. Detailed, longitudinal data collection from wearables presents a valuable opportunity to identify new factors associated with CVD.
Methods And Results:
This cross-sectional study analyzed 6947 participants in the Fitbit Bring-Your-Own-Device Project, a subset of the All of Us Research Program. The primary exposure daily heart rate per step (DHRPS) was defined as the average daily heart rate divided by steps per day. Our analysis correlated DHRPS with established CVD factors (type 2 diabetes, hypertension, stroke, heart failure, coronary atherosclerosis, myocardial infarction) as primary outcomes. We also performed a DHRPS-based phenome-wide association study on the spectrum of human disease traits for all 1789 disease codes across 17 disease categories. Secondary outcomes included maximum metabolic equivalents achieved on cardiovascular treadmill exercise stress testing. We examined 5.8 million person-days and 51 billion total steps of individual-level Fitbit data paired with electronic health record data. Elevated DHRPS was associated with type 2 diabetes (odds ratio [OR], 2.03 [95% CI, 1.70-2.42]), hypertension (OR, 1.63 [95% CI, 1.32-2.02]), heart failure (OR, 1.77 [95% CI, 1.00-3.14]), and coronary atherosclerosis (OR, 1.44 [95% CI, 1.14-1.82]), even after adjusting for daily heart rate (DHR) and step count. DHRPS also had stronger correlations with maximum metabolic equivalents achieved on exercise stress testing compared with steps per day (∆ρ=0.04, P<0.001) and heart rate (∆ρ=0.31, P<0.001). Lastly, DHRPS-based phenome-wide association study demonstrated stronger associations with CVD factors (P<1×10-55) compared with daily heart rate or step count.
Conclusions:
In the All of Us Research Program Fitbit Bring-Your-Own-Device Project, DHRPS was an easy-to-calculate wearables metric and was more strongly associated with cardiovascular fitness and CVD outcomes than DHR and step count.
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