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Protective Role of Resting Heart Rate on All-Cause and Cardiovascular Disease Mortality



      To study the protective role of lower resting heart rate (RHR) in cardiovascular disease (CVD) and all-cause mortality.

      Patients and Methods

      Patients (n=53,322) who received a baseline medical examination between January 1, 1974, and December 31, 2002, were recruited from the Cooper Clinic, Dallas, Texas. They completed a medical questionnaire and underwent clinical evaluation. Patients with CVD or cancer or who had less than 1 year of mortality follow-up were excluded from the study. Relative risks and 95% CIs for all-cause and CVD mortality across RHR categories were estimated using Cox proportional hazards models.


      Highest cardiorespiratory fitness with lower mortality was found in individuals with an RHR of less than 60 beats/min. Similarly, patients with a higher RHR (≥80 beats/min) were at greater risk for CVD and all-cause mortality compared with an RHR of less than 60 beats/min. This analysis was followed by stratification of the data by hypertension, where hypertensive individuals with high RHRs (≥80 beats/min) were found to be at greater risk for CVD and all-cause mortality compared with those with hypertension and lower RHRs (<60 beats/min). In addition, unfit individuals with high RHRs had the greatest risk of CVD and all-cause mortality. The unfit with low RHR group had a similar risk for CVD and all-cause mortality as the fit with high RHR group.


      Lower cardiorespiratory fitness levels and higher RHRs are linked to greater CVD and all-cause mortality.

      Abbreviations and Acronyms:

      ACLS (Aerobics Center Longitudinal Study), BP (blood pressure), CHD (coronary heart disease), CRF (cardiorespiratory fitness), CV (cardiovascular), CVD (cardiovascular disease), HR (hazard ratio), HTN (hypertension), PA (physical activity), RHR (resting heart rate)
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        • Fox K.
        • Borer J.S.
        • Camm A.J.
        • et al.
        Resting heart rate in cardiovascular disease.
        J Am Coll Cardiol. 2007; 50: 823-830
        • Palatini P.
        • Casiglia E.
        • Pauletto P.
        • Staessen J.
        • Kaciroti N.
        • Julius S.
        Relationship of tachycardia with high blood pressure and metabolic abnormalities: a study with mixture analysis in three populations.
        Hypertension. 1997; 30: 1267-1273
        • Kolloch R.
        • Legler U.F.
        • Champion A.
        • et al.
        Impact of resting heart rate on outcomes in hypertensive patients with coronary artery disease: findings from the INternational VErapamil-SR/trandolapril STudy (INVEST).
        Eur Heart J. 2008; 29: 1327-1334
        • Cook S.
        • Togni M.
        • Schaub M.C.
        • Wenaweser P.
        • Hess O.M.
        High heart rate: a cardiovascular risk factor?.
        Eur Heart J. 2006; 27: 2387-2393
        • Jouven X.
        • Zureik M.
        • Desnos M.
        • Guerot C.
        • Ducimetiere P.
        Resting heart rate as a predictive risk factor for sudden death in middle-aged men.
        Cardiovasc Res. 2001; 50: 373-378
        • 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
        • Kristal-Boneh E.
        • Silber H.
        • Harari G.
        • Froom P.
        The association of resting heart rate with cardiovascular, cancer and all-cause mortality: eight year follow-up of 3527 male Israeli employees (the CORDIS Study).
        Eur Heart J. 2000; 21: 116-124
        • Du X.
        • Ninomiya T.
        • de Galan B.
        • et al.
        Risks of cardiovascular events and effects of routine blood pressure lowering among patients with type 2 diabetes and atrial fibrillation: results of the ADVANCE study.
        Eur Heart J. 2009; 30: 1128-1135
        • 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
        • Tangeraas T.
        • Midtvedt K.
        • Fredriksen P.M.
        • Cvancarova M.
        • Morkrid L.
        • Bjerre A.
        Cardiorespiratory fitness is a marker of cardiovascular health in renal transplanted children.
        Pediatr Nephrol. 2010; 25: 2343-2350
        • Grundy S.M.
        • Barlow C.E.
        • Farrell S.W.
        • Vega G.L.
        • Haskell W.L.
        Cardiorespiratory fitness and metabolic risk.
        Am J Cardiol. 2012; 109: 988-993
        • Rheaume C.
        • Arsenault B.J.
        • Dumas M.P.
        • et al.
        Contributions of cardiorespiratory fitness and visceral adiposity to six-year changes in cardiometabolic risk markers in apparently healthy men and women.
        J Clin Endocrinol Metab. 2011; 96: 1462-1468
        • Powell K.E.
        • Paluch A.E.
        • Blair S.N.
        Physical activity for health: what kind? how much? how intense? on top of what?.
        Annu Rev Public Health. 2011; 32: 349-365
        • Meriwether R.A.
        • Lee J.A.
        • Lafleur A.S.
        • Wiseman P.
        Physical activity counseling.
        Am Fam Physician. 2008; 77: 1129-1136
        • Brosnan E.A.
        • Eales M.M.
        The erythrocyte sedimentation rate in pregnancy.
        N Z Med J. 1990; 103: 278
        • Lee D.C.
        • Artero E.G.
        • Sui X.
        • Blair S.N.
        Mortality trends in the general population: the importance of cardiorespiratory fitness.
        J Psychopharmacol. 2010; 24: 27-35
        • Blair S.N.
        • Goodyear N.N.
        • Gibbons L.W.
        • Cooper K.H.
        Physical fitness and incidence of hypertension in healthy normotensive men and women.
        JAMA. 1984; 252: 487-490
        • Cheng Y.J.
        • Macera C.A.
        • Church T.S.
        • Blair S.N.
        Heart rate reserve as a predictor of cardiovascular and all-cause mortality in men.
        Med Sci Sports Exerc. 2002; 34: 1873-1878
        • Perloff D.
        • Grim C.
        • Flack J.
        • et al.
        Human blood pressure determination by sphygmomanometry.
        Circulation. 1993; 88: 2460-2470
        • Balke B.
        • Ware R.W.
        An experimental study of physical fitness of Air Force personnel.
        U S Armed Forces Med J. 1959; 10: 675-688
        • Lee D.C.
        • Sui X.
        • Church T.S.
        • Lee I.M.
        • Blair S.N.
        Associations of cardiorespiratory fitness and obesity with risks of impaired fasting glucose and type 2 diabetes in men.
        Diabetes Care. 2009; 32: 257-262
        • Sui X.
        • LaMonte M.J.
        • Laditka J.N.
        • et al.
        Cardiorespiratory fitness and adiposity as mortality predictors in older adults.
        JAMA. 2007; 298: 2507-2516
        • Nauman J.
        • Aspenes S.T.
        • Nilsen T.I.
        • Vatten L.J.
        • Wisloff U.
        A prospective population study of resting heart rate and peak oxygen uptake (the HUNT Study, Norway).
        PLoS One. 2012; 7: e45021
        • Jouven X.
        • Empana J.P.
        • Escolano S.
        • et al.
        Relation of heart rate at rest and long-term (>20 years) death rate in initially healthy middle-aged men.
        Am J Cardiol. 2009; 103: 279-283
        • 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
        • Paul L.
        • Hastie C.E.
        • Li W.S.
        • et al.
        Resting heart rate pattern during follow-up and mortality in hypertensive patients.
        Hypertension. 2010; 55: 567-574
        • Dyer A.R.
        • Persky V.
        • Stamler J.
        • et al.
        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
        • Shaper A.G.
        • Ashby D.
        • Pocock S.J.
        Blood pressure and hypertension in middle-aged British men.
        J Hypertens. 1988; 6: 367-374
        • Shaper A.G.
        • Wannamethee G.
        • Macfarlane P.W.
        • Walker M.
        Heart rate, ischaemic heart disease, and sudden cardiac death in middle-aged British men.
        Br Heart J. 1993; 70: 49-55
        • Thompson P.D.
        • Buchner D.
        • Pina I.L.
        • et al.
        Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease: a statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity).
        Circulation. 2003; 107: 3109-3116
        • Bouchard C.
        • Daw E.W.
        • Rice T.
        • et al.
        Familial resemblance for VO2max in the sedentary state: the HERITAGE family study.
        Med Sci Sports Exerc. 1998; 30: 252-258
        • Bouchard C.
        • An P.
        • Rice T.
        • et al.
        Familial aggregation of VO(2max) response to exercise training: results from the HERITAGE Family Study.
        J Appl Physiol. 1999; 87: 1003-1008
        • Hsia J.
        • Larson J.C.
        • Ockene J.K.
        • et al.
        Resting heart rate as a low tech predictor of coronary events in women: prospective cohort study.
        BMJ. 2009; 338: b219
        • Rognmo O.
        • Moholdt T.
        • Bakken H.
        • et al.
        Cardiovascular risk of high- versus moderate-intensity aerobic exercise in coronary heart disease patients.
        Circulation. 2012; 126: 1436-1440
        • Veiga O.L.
        • Gomez-Martinez S.
        • Martinez-Gomez D.
        • et al.
        Physical activity as a preventive measure against overweight, obesity, infections, allergies and cardiovascular disease risk factors in adolescents: AFINOS Study protocol.
        BMC Public Health. 2009; 9: 475
        • Dimmeler S.
        • Zeiher A.M.
        Exercise and cardiovascular health: get active to “AKTivate” your endothelial nitric oxide synthase.
        Circulation. 2003; 107: 3118-3120
        • Golbidi S.
        • Laher I.
        Molecular mechanisms in exercise-induced cardioprotection.
        Cardiol Res Pract. 2011; 2011: 972807
        • Arnold J.M.
        • Fitchett D.H.
        • Howlett J.G.
        • Lonn E.M.
        • Tardif J.C.
        Resting heart rate: a modifiable prognostic indicator of cardiovascular risk and outcomes?.
        Can J Cardiol. 2008; 24: 3A-8A
        • La Rovere M.T.
        • Bersano C.
        • Gnemmi M.
        • Specchia G.
        • Schwartz P.J.
        Exercise-induced increase in baroreflex sensitivity predicts improved prognosis after myocardial infarction.
        Circulation. 2002; 106: 945-949
        • Guiraud T.
        • Labrunee M.
        • Gaucher-Cazalis K.
        • et al.
        High-intensity interval exercise improves vagal tone and decreases arrhythmias in chronic heart failure.
        Med Sci Sports Exerc. 2013; 45: 1861-1867
        • Sui X.
        • LaMonte M.J.
        • Blair S.N.
        Cardiorespiratory fitness as a predictor of nonfatal cardiovascular events in asymptomatic women and men.
        Am J Epidemiol. 2007; 165: 1413-1423
        • Sui X.
        • Hooker S.P.
        • Lee I.M.
        • et al.
        A prospective study of cardiorespiratory fitness and risk of type 2 diabetes in women.
        Diabetes Care. 2008; 31: 550-555