Gender-specific trends in heart rate in the general population from 1992-2007: a study of 226,288 French adults

Gender gap in annual preventive care services in France

BACKGROUND

In France, screening for cardiovascular risk factors is recommended during annual preventive visits. However, data are lacking on the temporal trend in women's uptake to preventive care services, and in cardiovascular and mortality outcomes. The aim of the study was to investigate the participation and mortality of women in annual preventive care services in a major preventive medicine center in France.

METHOD

Ee conducted repeated cross-sectional studies including a total of 366,270 individuals who had a first examination at the Centre d'Investigations Préventives et Cliniques, France, between January 1992 and December 2011.

FINDINGS

Women's participation was low below 50 years of age, then increases from 50 to 70 years, and is lower for women older than 70 years. The gap in female participation was more pronounced among individuals with high education, low social deprivation, and no depressive symptoms. Compared with the general population, the screened population had significantly lower standardized mortality ratios (SMRs) among both men and women, for all age ranges. Screened women aged 18-49 years showed a lower mortality gain compared with men of the same age; SMRs did not differ significantly by sex for individuals over 50 years.

INTERPRETATION

In this community-based sample, compared with men, women's participation to annual preventive care services was lower, and screened women had a lower mortality gain. Despite the demonstrated benefit of annual check-ups on health, there is a gender gap in adherence to preventive programs and in efficiency of screening programs, especially in the young age range. This gap in cardiovascular disease prevention may result in poorer cardiovascular health in women. Urgent adaptations to overcome this gender gap in preventive screening in France are warranted.

FUNDING

Bamba Gaye is supported by the Fondation Recherche Médicale grant.

Association between clustering of cardiovascular risk factors and resting heart rate in Chinese population: a cross-sectional study

BACKGROUND

Epidemiologic studies have explored the association between a single cardiovascular risk factor (CVRF) and resting heart rate (RHR), but the research on the relation of multiple risk factors with RHR remains scarce. This study aimed to explore the associations between CVRFs clustering and the risk of elevated RHR.

METHODS

In this cross-sectional study, adults aged 35-75 years from 31 provinces were recruited by the China PEACE Million Persons Projects from September 2015 to August 2020. We focused on seven risk factors: hypertension, diabetes mellitus, dyslipidemia, obesity, smoking, alcohol use, and low physical activity. Multivariate logistic regression was used to calculate odds ratios (OR) for elevated RHR (> 80 beats/min).

RESULTS

Among 1,045,405 participants, the mean age was 55.67 ± 9.86 years, and 60.4% of participants were women. The OR (95% CI) for elevated RHR for the groups with 1, 2, 3, 4 and ≥ 5 risk factor were 1.11 (1.08-1.13), 1.36 (1.33-1.39), 1.68 (1.64-1.72), 2.01 (1.96-2.07) and 2.58 (2.50-2.67), respectively (P _trend < 0.001). The association between the CVRFs clustering number and elevated RHR was much more pronounced in young males than in other age-sex subgroups. Clusters comprising more metabolic risk factors were associated with a higher risk of elevated RHR than those comprising more behavioral risk factors.

CONCLUSIONS

There was a significant positive association between the CVRFs clustering number and the risk of elevated RHR, particularly in young males. Compared clusters comprising more behavioral risk factors, clusters comprising more metabolic risk factors were associated with a higher risk of elevated RHR. RHR may serve as an indicator of the cumulative effect of multiple risk factors.

Temporal trends of cardiovascular health factors among 366 270 French adults

AIMS

We aimed to investigate time trends in cardiovascular health (CVH) metrics in the population at large, as well as in important subgroups.

METHODS AND RESULTS

In this study, we used a community-based sample of 366 270 adults from France who had a standardized examination to assess cardiovascular risk factors between 1992 and 2011 (20 years). Cardiovascular health metrics categorized into ideal, intermediate, and poor categories were computed using smoking, physical activity, body mass index, total cholesterol, blood glucose, and blood pressure. Matching on age, sex, and depression across 5-year periods (1992-96, 1997-2001, 2002-06, and 2007-11) was performed in order to correct for the sociodemographic differences between the examinations at different periods of times. Mean age across all four time periods was 44.7 (SD 13) years and 38% (138 228) were women. Overall, few participants (≤3.5%) met all six ideal CVH metrics at any time point. The prevalence of meeting ≥5 ideal CVH metrics increased from 6.7% in 1992-96 to 15.0% in 2007-11 (P < 0.001). A significant improvement in CVH (meeting ≥5 ideal CVH metrics) from 1992 to 2011 was observed among younger (from 7.5% to 16.6%) and older individuals (from 1.3% to 4.2%), men (from 4.4% to 11.8%) and women (from 10.4% to 20.1%), those with low (from 9.1% to 10.4%) and high education status (from 15% to 18.1%) and those with (from 5.1% to 12.7%) and without depressive symptoms (from 6.8% to 15.1%). However, the rate of improvement was steepest in the most affluent group in comparison with those with lower socio-economic status.

CONCLUSION

Overall CVH improved from 1992 until 2006 and slightly decreased between 2006 and 2011 in French adults. From 1992 until 2006, the improvement in CVH was less pronounced among those with low socio-economic status as compared to those with a higher socio-economic status.

Exercise capacity and body mass index - important predictors of change in resting heart rate

BACKGROUND

Resting heart rate (RHR) is an obtainable, inexpensive, non-invasive test, readily available on any medical document. RHR has been established as a risk factor for cardiovascular morbidity, is related to other cardiovascular risk factors, and may possibly predict them. Change in RHR over time (∆RHR) has been found to be a potential predictor of mortality.

METHODS

In this prospective study, RHR and ∆RHR were evaluated at baseline and over a period of 2.9 years during routine check-ups in 6683 subjects without known cardiovascular disease from the TAMCIS: Tel-Aviv Medical Center Inflammation Survey. Multiple linear regression analysis with three models was used to examine ∆RHR. The first model accounted for possible confounders by adjusting for age, sex and body mass index (BMI). The 2nd model included smoking status, baseline RHR, diastolic blood pressure (BP), dyslipidemia, high-density lipoprotein (HDL) and metabolic equivalents of task (MET), and in the last model the change in MET and change in BMI were added.

RESULTS

RHR decreased with age, even after adjustment for sex, BMI and MET. The mean change in RHR was - 1.1 beats/min between two consecutive visits, in both men and women. This ∆RHR was strongly correlated with baseline RHR, age, initial MET, and change occurring in MET and BMI (P < 0.001).

CONCLUSIONS

Our results highlight the need for examining individual patients' ∆RHR. Reinforcing that a positive ∆RHR is an indicator of poor adherence to a healthy lifestyle.

Resting heart rate and the risk of hypertension and heart failure: a dose-response meta-analysis of prospective studies

BACKGROUND

Studies on the relationship of resting heart rate to the risks of hypertension and heart failure have been inconsistent, and the question as to whether there is a linear association between them is unanswered.

OBJECTIVE

To evaluate this possible relationship, we carried out a dose-response meta-analysis of studies that looked at risks associated with resting heart rate and hypertension or heart failure.

METHODS

We searched PubMed, Embase, CNKI and WanFang databases for articles published before 15 June 2017. A random-effect model was used to pool relative risks and 95% confidence intervals. Restricted cubic spline analysis was used to model the resting heart rate-hypertension and heart failure risk association.

RESULTS

We identified 13 and 17 cohort studies for hypertension and heart failure, respectively. The risk for each disease, respectively, increased by 11% relative risk: 1.11 (95% confidence interval: 1.07-1.15) and 19% relative risk: 1.19 (95% confidence interval: 1.13-1.25) for each 10 beats-per-minute increment in resting heart rate. The relationship between resting heart rate and hypertension or heart failure was consistent in most subgroup analyses except for gender subgroups, with no significant association observed in the women subgroup. The results provide no evidence of a nonlinear association of elevated resting heart rate with hypertension and heart failure risk.

CONCLUSION

Resting heart rate shows a linear positive association with the incidence of hypertension and heart failure.

Resting heart rate predicts incident myocardial infarction, atrial fibrillation, ischaemic stroke and death in the general population: the Tromsø Study

BACKGROUND

Elevated resting heart rate (RHR) increases risk of death overall, but a comprehensive picture of the associations between RHR, cardiovascular morbidity and mortality events has not yet been presented. We aimed to investigate the effect of RHR on the risk of 5 cardiovascular events: incident myocardial infarction (MI), incident atrial fibrillation (AF), incident ischaemic stroke, total death and cardiovascular death in a general population from Norway.

METHODS

We followed 24 489 men and women from the Tromsø Study 1994-1995, a population-based cohort study, for 18 years, and analysed the association between RHR and the investigated cardiovascular events. Sex-specific Cox regression with time-dependent covariates was applied with the best-fitting fractional polynomials of RHR.

RESULTS

Among men, an independent positive relationship was observed for MI and AF (adjusted HR for AF per 20 bpm increase=1.14; 95% CI 1.02 to 1.27). In women, the corresponding HR for MI was 1.23 (1.09 to 1.40). A J-shaped association was observed for ischaemic stroke in women when compared with a RHR of 70 bpm (HR for 50 bpm=1.31; 0.90 to 1.90; HR for 100 bpm=1.32; 1.04 to 1.69). Total and cardiovascular death showed a strong positive association with RHR in men. In women, the pattern for total death was similar.

CONCLUSIONS

RHR is an independent risk factor for several cardiovascular events. A novel finding is the positive association between RHR and AF in men and the sex difference in association with ischaemic stroke.

Resting heart rate and all-cause and cardiovascular mortality in the general population: a meta-analysis

BACKGROUND

Data on resting heart rate and risk of all-cause and cardiovascular mortality are inconsistent; the magnitude of associations between resting heart rate and risk of all-cause and cardiovascular mortality varies across studies. We performed a meta-analysis of prospective cohort studies to quantitatively evaluate the associations in the general population.

METHODS

We searched PubMed, Embase and MEDLINE from inception to Jan. 1, 2015. We used a random-effects model to combine study-specific relative risks and 95% confidence intervals (CIs). We used restricted cubic spline functions to assess the dose-response relation.

RESULTS

A total of 46 studies were included in the meta-analysis, involving 1 246 203 patients and 78 349 deaths for all-cause mortality, and 848 320 patients and 25 800 deaths for cardiovascular mortality. The relative risk with 10 beats/min increment of resting heart rate was 1.09 (95% CI 1.07-1.12) for all-cause mortality and 1.08 (95% CI 1.06-1.10) for cardiovascular mortality. Compared with the lowest category, patients with a resting heart rate of 60-80 beats/min had a relative risk of 1.12 (95% CI 1.07-1.17) for all-cause mortality and 1.08 (95% CI 0.99-1.17) for cardiovascular mortality, and those with a resting heart rate of greater than 80 beats/min had a relative risk of 1.45 (95% CI 1.34-1.57) for all-cause mortality and 1.33 (95% CI 1.19-1.47) for cardiovascular mortality. Overall, the results did not differ after adjustment for traditional risk factors for cardiovascular disease. Compared with 45 beats/min, the risk of all-cause mortality increased significantly with increasing resting heart rate in a linear relation, but a significantly increased risk of cardiovascular mortality was observed at 90 beats/min. Substantial heterogeneity and publication bias were detected.

INTERPRETATION

Higher resting heart rate was independently associated with increased risks of all-cause and cardiovascular mortality. This indicates that resting heart rate is a predictor of all-cause and cardiovascular mortality in the general population.

Resting heart rate on the decline: the Tromsø Study 1986-2007

BACKGROUND

We examined secular changes in resting heart rate (RHR) and their relationship with changes in other cardiovascular risk factors in adult men and women over a 22-year period.

METHODS

A single-centre population-based longitudinal study comprised 30,699 men and women aged 30-89 years who participated in at least one of the 1986, 1994, 2001 and 2007 surveys of the Tromsø Study, Tromsø, Norway.

RESULTS

During the study period, the age-adjusted means of RHR declined from 73.4 to 64.7 beats per minute (b.p.m.) in men, and from 78.3 to 66.4 b.p.m. in women. The decline was persistent from one survey to the next and was of similar size in both sexes and for all age groups and birth cohorts. RHR declined gradually over time for different levels of cardiovascular risk factors, and it declined more in those who moved from adverse to favourable values or categories of blood pressure, total and high-density lipoprotein cholesterol, triglycerides, body mass index, smoking and physical activity, and those who started to take blood pressure medication. The strongest predictors of individual decline in RHR were decrease in systolic blood pressure and triglycerides, increase in physical activity, taking blood pressure treatment and smoking cessation.

CONCLUSION

A considerable decline in RHR has occurred in Tromsø over the past two decades in men and women of all ages. The decline is partly related to changes in several cardiovascular risk factors, and reasons behind this need to be further elucidated. The findings suggest that new definitions of normal RHR may be needed.

Latent time-varying factors in longitudinal analysis: a linear mixed hidden Markov model for heart rates

Longitudinal data are often segmented by unobserved time-varying factors, which introduce latent heterogeneity at the observation level, in addition to heterogeneity across subjects. We account for this latent structure by a linear mixed hidden Markov model. It integrates subject-specific random effects and Markovian sequences of time-varying effects in the linear predictor. We propose an expectationŰ-maximization algorithm for maximum likelihood estimation, based on data augmentation. It reduces to the iterative maximization of the expected value of a complete likelihood function, derived from an augmented dataset with case weights, alternated with weights updating. In a case study of the Survey on Stress Aging and Health in Russia, the model is exploited to estimate the influence of the observed covariates under unobserved time-varying factors, which affect the cardiovascular activity of each subject during the observation period.

Metabolic syndrome is associated with and predicted by resting heart rate: a cross-sectional and longitudinal study

OBJECTIVE

Although higher resting heart rate (RHR) has emerged as a predictor for lifespan, the underlying mechanisms remain obscure. The present study investigates whether a positive relationship exists between RHR and metabolic syndrome (MetS) and whether RHR predicts future MetS.

METHODS

A cohort of 89,860 participants were surveyed during 2006-2007 in Kailuan/Tangshan, China. MetS was diagnosed when a participant presented at least three of the following: abdominal adiposity, low high density lipoprotein-cholesterol, high triglycerides, hypertension or impaired fasting glucose. RHR was derived from ECG recordings and subjects were stratified based on RHR. Some participants without MetS at baseline were followed-up for 4 years.

RESULTS

At baseline, 23,150 participants (25.76%) had MetS. There was a positive association between RHR and MetS. The OR of having MetS was 1.49 (95% CI 1.32 to 1.69) in subjects with RHR at 95-104 compared with those at 55-64 beats per minute (bpm) (reference), after adjusting for variables including age, sex, education, cigarette smoking, alcohol drinking, physical activities, body mass index, hypertension, diabetes, hyperlipidaemia, inflammatory biomarkers and renal function. More importantly, when 43,725 individuals from the original study without MetS at baseline were followed-up, higher RHR was found to predict greater risk of MetS incidence. The OR of developing MetS 4 years later was 1.41 (95% CI 1.21 to 1.65) in subjects with RHR at 95-104 bpm compared with reference, after all adjustments.

CONCLUSIONS

Our cross-sectional and longitudinal findings provide evidence that RHR is an independent risk factor for existing MetS and a powerful predictor for future incidence of MetS.

Association of resting heart rate with cardiovascular function: a cross-sectional study in 522 Finnish subjects

Background

High resting heart rate (HR) is associated with increased cardiovascular risk in general populations, possibly due to elevated blood pressure (BP) or sympathetic over-activity. We studied the association of resting HR with cardiovascular function, and examined whether the hemodynamics remained similar during passive head-up tilt.

Methods

Hemodynamics were recorded using whole-body impedance cardiography and continuous radial pulse wave analysis in 522 subjects (age 20–72 years, 261 males) without medication influencing HR or BP, or diagnosed diabetes, coronary artery, renal, peripheral arterial, or cerebrovascular disease. Correlations were calculated, and results analysed according to resting HR tertiles.

Results

Higher resting HR was associated with elevated systolic and diastolic BP, lower stroke volume but higher cardiac output and work, and lower systemic vascular resistance, both supine and upright (p < 0.05 for all). Subjects with higher HR also showed lower supine and upright aortic pulse pressure and augmentation index, and increased resting pulse wave velocity (p < 0.001). Upright stroke volume decreased less in subjects with highest resting HR (p < 0.05), and cardiac output decreased less in subjects with lowest resting HR (p < 0.009), but clear hemodynamic differences between the tertiles persisted both supine and upright.

Conclusions

Supine and upright hemodynamic profile associated with higher resting HR is characterized by higher cardiac output and lower systemic vascular resistance. Higher resting HR was associated with reduced central wave reflection, in spite of elevated BP and arterial stiffness. The increased cardiac workload, higher BP and arterial stiffness, may explain why higher HR is associated with less favourable prognosis in populations.

Trial registration

ClinicalTrials.gov, NCT01742702

Double product reflects the predictive power of systolic pressure in the general population: evidence from 9,937 participants

BACKGROUND

The double product (DP), consisting of the systolic blood pressure (SBP) multiplied by the pulse rate (PR), is an index of myocardial oxygen consumption, but its prognostic value in the general population remains unknown.

METHODS

We recorded health outcomes in 9,937 subjects (median age, 53.2 years; 47.3% women) randomly recruited from 11 populations and enrolled in the International Database on Ambulatory blood pressure in relation to Cardiovascular Outcomes (IDACO) study. We obtained the SBP, PR, and DP for these subjects as determined through 24-hour ambulatory monitoring.

RESULTS

Over a median period of 11.0 years, 1,388 of the 9,937 study subjects died, of whom 536 and 794, respectively, died of cardiovascular (CV) and non-CV causes, and a further 1,161, 658, 494, and 465 subjects, respectively, experienced a CV, cardiac, coronary, or cerebrovascular event. In multivariate-adjusted Cox models, not including SBP and PR, DP predicted total, CV, and non-CV mortality (standardized hazard ratio [HR], ≥ 1.10; P ≤ 0.02), and all CV, cardiac, coronary, and stroke events (HR, ≥ 1.21; P < 0.0001). For CV mortality (HR, 1.34 vs. 1.30; P = 0.71) and coronary events (1.28 vs. 1.21; P = 0.26), SBP and the DP were equally predictive. As compared with DP, SBP was a stronger predictor of all CV events (1.39 vs. 1.27; P = 0.002) and stroke (1.61 vs. 1.36; P < 0.0001), and a slightly stronger predictor of cardiac events (1.32 vs. 1.22; P = 0.06). In fully adjusted models, including both SBP and PR, the predictive value of DP disappeared for fatal endpoints (P ≥ 0.07), coronary events (P = 0.06), and stroke (P = 0.12), or DP was even inversely associated with the risk of all CV and cardiac events (both P ≤ 0.01).

CONCLUSION

In the general population, we did not observe DP to add to risk stratification over and beyond SBP and PR.

A prospective population study of resting heart rate and peak oxygen uptake (the HUNT Study, Norway)

Objectives

We assessed the prospective association of resting heart rate (RHR) at baseline with peak oxygen uptake (VO_2peak) 23 years later, and evaluated whether physical activity (PA) could modify this association.

Background

Both RHR and VO_2peak are strong and independent predictors of cardiovascular morbidity and mortality. However, the association of RHR with VO_2peak and modifying effect of PA have not been prospectively assessed in population studies.

Methods

In 807 men and 810 women free from cardiovascular disease both at baseline (1984–86) and follow-up 23 years later, RHR was recorded at both occasions, and VO_2peak was measured by ergospirometry at follow-up. We used Generalized Linear Models to assess the association of baseline RHR with VO_2peak, and to study combined effects of RHR and self-reported PA on later VO_2peak.

Results

There was an inverse association of RHR at baseline with VO_2peak (p<0.01). Men and women with baseline RHR greater than 80 bpm had 4.6 mL·kg⁻¹·min⁻¹ (95% confidence interval [CI], 2.8 to 6.3) and 1.4 mL·kg⁻¹·min⁻¹ (95% CI, −0.4 to 3.1) lower VO_2peak at follow-up compared with men and women with RHR below 60 bpm at baseline. We found a linear association of change in RHR with VO_2peak (p = 0.03), suggesting that a decrease in RHR over time is likely to be beneficial for cardiovascular fitness. Participants with low RHR and high PA at baseline had higher VO_2peak than inactive people with relatively high RHR. However, among participants with relatively high RHR and high PA at baseline, VO_2peak was similar to inactive people with relatively low RHR.

Conclusion

RHR is an important predictor of VO_2peak, and serial assessments of RHR may provide useful and inexpensive information on cardiovascular fitness. The results suggest that high levels of PA may compensate for the lower VO_2peak associated with a high RHR.