Open AccessLong‐term Cardiovascular Risks Associated With an Elevated Heart Rate: The F ramingham Heart Study
Author(s) -
Ho Jennifer E.,
Larson Martin G.,
Ghorbani Anahita,
Cheng Susan,
Coglianese Erin E.,
Vasan Ramachandran S.,
Wang Thomas J.
Publication year - 2014
Publication title -
journal of the american heart association
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.494
H-Index - 85
ISSN - 2047-9980
DOI - 10.1161/jaha.113.000668
Subject(s) - medicine , heart failure , framingham heart study , hazard ratio , cardiology , heart rate , framingham risk score , myocardial infarction , proportional hazards model , stroke (engine) , heart disease , blood pressure , confidence interval , disease , mechanical engineering , engineering
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.