Miscellaneous| Volume 103, ISSUE 2, P279-283, January 15, 2009

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Relation of Heart Rate at Rest and Long-Term (>20 Years) Death Rate in Initially Healthy Middle-Aged Men

Published:November 10, 2008DOI:
      The prognostic implications of heart rate (HR) change over years have never been assessed. It was hypothesized that an increase in HR in apparently healthy persons observed over years could be associated with an increase in mortality risk and conversely. A total of 5,139 asymptomatic working men (aged 42 to 53 years) free of clinically detectable cardiovascular disease were recruited from 1967 to 1972 and had their HRs measured at rest in standardized conditions every year for 5 consecutive years. HR change was defined as the difference between HR at examination 5 and HR at inclusion, and subjects were divided into tertiles according to decrease >4 beats/min, unchanged (from −4 to +3 beats/min), and increase >3 beats/min. After >20 years of mortality surveillance, 1,219 deaths were observed. After adjustments were made for confounding factors, including baseline HR at rest, and compared with subjects with unchanged HRs, subjects with decreased HRs during the 5 years had a 14% decreased mortality risk (RR 0.86, 95% confidence interval 0.74 to 1.00, p = 0.05), whereas subjects with increased HRs during the 5 years had a 19% increased mortality risk (RR 1.19, and 95% confidence interval 1.04 to 1.37, p <0.012). In conclusion, change in HR at rest over 5 years was an independent predictor of mortality in middle-aged men.
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        • Bruce T.A.
        • Chapman C.P.
        • Baker O.
        • Fisher J.N.
        Role of autonomic and myocardial factors in cardiac control.
        J Clin Invest. 1963; 42: 721-726
      1. Randall W.C. Neural Regulation of the Heart. Oxford University, New York1977: 440-444
        • Levy M.N.
        • Martin P.J.
        Neural control of the heart.
        in: Sperelakis N. Physiology and Pathophysiology of the Heart. Nijhoff, Boston, MA1984: 337-354
        • Watanabe A.M.
        • Lindemann J.P.
        Mechanism of adrenergic and cholinergic regulation of myocardial contractility.
        in: Sperelakis N. Physiology and Pathophysiology of the Heart. Nijhoff, Boston, MA1984: 354-404
        • Palatini P.
        Heart rate: a strong predictor of mortality in subjects with coronary artery disease.
        Eur Heart J. 2005; 26: 943-945
        • Diaz A.
        • Bourassa M.G.
        • Guertin M.C.
        • Tardif J.C.
        Long-term prognostic value of resting heart rate in patients with suspected or proven coronary artery disease.
        Eur Heart J. 2005; 26: 967-974
        • Dyer A.R.
        • Persky V.
        • Stamler J.
        • Paul O.
        • Shekelle R.B.
        • Berkson D.M.
        • Lepper M.
        • Schoenberger J.A.
        • Lindberg H.A.
        Heart rate as a prognostic factor for coronary heart disease and mortality: findings in three Chicago epidemiologic studies.
        Am J Epidemiol. 1980; 112: 736-749
        • Kannel W.B.
        • Kannel C.
        • Paffenbarger Jr., R.S.
        • Cupples L.A.
        Heart rate and cardiovascular mortality: the Framingham Study.
        Am Heart J. 1987; 113: 1489-1494
        • Gillum R.F.
        • Makuc D.M.
        • Feldman J.J.
        Pulse rate, coronary heart disease, and death: the NHANES I Epidemiologic Follow-up Study.
        Am Heart J. 1991; 121: 172-177
        • Benetos A.
        • Rudnichi A.
        • Thomas F.
        • Safar M.
        • Guize L.
        Influence of heart rate on mortality in a French population: role of age, gender, and blood pressure.
        Hypertension. 1999; 33: 44-52
        • Palatini P.
        • Casiglia E.
        • Julius S.
        • Pessina A.C.
        High heart rate: a risk factor for cardiovascular death in elderly men.
        Arch Intern Med. 1999; 159: 585-592
        • Jouven X.
        • Zureik M.
        • Desnos M.
        • Guerot C.
        • Ducimetière P.
        Resting heart rate as a predictive risk factor for sudden death in middle-aged men.
        Cardiovasc Res. 2001; 50: 373-378
        • Chang M.
        • Havlik R.J.
        • Corti M.C.
        • Chaves P.H.
        • Fried L.P.
        • Guralnik J.M.
        Relation of heart rate at rest and mortality in the Women's Health and Aging Study.
        Am J Cardiol. 2003; 92: 1294-1299
        • Ducimetiere P.
        • Cambien F.
        • Richard J.L.
        • Rakotovao R.
        Coronary heart disease in middle-aged Frenchmen: comparison between Paris Prospective Study, Seven Countries Study and Pooling Project.
        Lancet. 1980; 1: 1346-1350
        • Jouven X.
        • Desnos M.
        • Guerot C.
        • Ducimetiere P.
        Predicting sudden death in the population: the Paris Prospective Study I.
        Circulation. 1999; 99: 1978-1983
        • Jouven X.
        • Empana J.P.
        • Schwartz P.J.
        • Desnos M.
        • Courbon D.
        • Ducimetiere P.
        Heart-rate profile during exercise as a predictor of sudden death.
        N Engl J Med. 2005; 352: 1951-1958
        • La Rovere M.T.
        • Bigger Jr., J.T.
        • Marcus F.I.
        • Mortara A.
        • Schwartz P.J.
        • ATRAMI (Autonomic Tone and Reflexes After Myocardial Infarction) Investigators
        Baroreflex sensitivity and heart rate variability in prediction of total cardiac mortality after myocardial infarction.
        Lancet. 1998; 351: 478-484
        • Kleiger R.E.
        • Miller J.P.
        • Bigger Jr., J.T.
        • Moss A.J.
        • Multicenter Postinfarction Research Group
        Decreased heart rate variability and its association with increased mortality after acute myocardial infarction.
        Am J Cardiol. 1987; 59: 256-262
        • Shishehbor M.H.
        • Litaker D.
        • Pothier C.E.
        • Lauer M.S.
        Association of socioeconomic status with functional capacity, heart rate recovery, and all-cause mortality.
        JAMA. 2006; 295: 784-792
        • Inoue T.
        • Iseki K.
        • Iseki C.
        • Kinjo K.
        • Ohya Y.
        • Takishita S.
        Higher heart rate predicts the risk of developing hypertension in a normotensive screened cohort.
        Circ J. 2007; 71: 1755-1760
        • Kaplan J.R.
        • Manuck S.B.
        • Adams M.R.
        • Weingand K.W.
        • Clarkson T.B.
        Inhibition of coronary atherosclerosis by propanolol in behaviourally predisposed monkeys fed an atherogenic diet.
        Circulation. 1987; 761: 1364-1372
        • Bassiouny H.S.
        • Zarins C.K.
        • Kadowaki M.H.
        • Glagov S.
        Hemodynamic stress and experimental aortoiliac atherosclerosis.
        J Vasc Surg. 1994; 19: 426-434
        • Beere P.A.
        • Glagov S.
        • Zarins C.K.
        Experimental atherosclerosis at the carotid bifurcation of the cynomolgus monkey.
        Arterioscler Thromb. 1992; 12: 1245-1253
        • Perski A.
        • Olsson G.
        • Landou C.
        • De Faire U.
        • Theorell T.
        • Hamsten A.
        Minimum heart rate and atherosclerosis: independent relations to global severity and rate of progression of angiographic lesions in men with myocardial infarction at young age.
        Am Heart J. 1992; 123: 609-616
        • Levine H.J.
        Rest heart rate and life expectancy.
        J Am Coll Cardiol. 1997; 30: 1104-1106
        • Azbel M.Y.
        Universal biological scaling and mortality.
        Proc Natl Acad Sci U S A. 1994; 91: 12453-12457
        • Ferrari R.
        • Nesta F.
        • Boraso A.
        Increased heart rate is detrimential: the myocardial metabolic theory.
        Eur Heart J. 1999; 1: H24-H28