Physicians' Academy for Cardiovascular Education

Higher resting heart rate in men 50 years old associated with higher CV risk in next 20 years

Impact of changes in heart rate with age on all-cause death and cardiovascular events in 50-year-old men from the general population

Literature - Chen X-j, Barywani SB, Hansson P-O et al., - Open Heart 2019. April 15.

Introduction and methods

Multiple studies have demonstrated an association between elevated resting heart rate (RHR) and a higher incidence of CV diseases, all-cause and CV mortality in the general population. The risk for CV morbidity and mortality increases in middle age, and RHR also changes with age.

The impact of the incremental change in RHR on incident CV morbidity and mortality in middle-aged general populations is unknown. This study therefore set out to assess the impact of RHR at baseline and the change in RHR over time on the risk of CV morbidity and mortality in middle-aged men, enrolled in ‘the study of men born in 1943’ [1]. This is a longitudinal, prospective, population-based study of men born in 1943 and living in the city of Gothenburg in Sweden when they were 50 years old.

A random sample of 50% of men qualifying for these criteria were invited (n=1450) in 1993, of whom 798 (55%) accepted to participate. At the second examination in 2003, 749 were still alive, of whom 654 agreed to be re-examined. At the third examination in 2014, 536 of 688 men still alive accepted to be re-examined. At each examination visit, medical history was obtained and a physical examination performed. During the 2014 visit an echocardiogram was made. Fasting venous blood samples were taken to determine plasma levels of total serum cholesterol, triglycerides, creatinine, HDL, NT-pro-BNP and IL-6. Questionnaires were used to get information on smoking habits, physical activity and family history of CVD, previous disease and mental stress.

RHR was measured with 12-lead ECG in supine position at each visit. The study sample was divided into four subgroups based on RHR in 1993: 1: RHR <55 beats per minute (bpm), 2: RHR 56-65 bpm, 3: 66-75 bpm and 4: RHR >75 bpm. Change in RHR (ΔHR) was calculated by subtracting RHR of 1993 from RHR in 2003. Three subgroups were then created according to ΔHR: 1: decreased RHR: ΔHR ≤-5bpm, stable RHR: -5bpm < ΔHR < 5 bpm and increased RHR: ΔHR ≥ 5 bpm. Outcome variables were all-cause mortality, CVD and coronary heart disease (CHD).

Main results


In men born in 1943 from the general population, baseline RHR in 1993 was an independent risk factor of all-cause death, CVD and CHD over a follow-up period of 21 years. Moreover, an increase in RHR between 50 and 60 years of age was associated with a higher risk of CVD compared with individuals with stable RHR. No significant difference was seen in CVD risk between those with increased and decreased RHR over time.


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