1
|
Kintsu M, Odajima S, Takeuchi K, Ichikawa Y, Todo S, Ota E, Yamauchi Y, Shiraki H, Yamashita K, Fukuda T, Hisamatsu E, Minami H, Hirata KI, Tanaka H. Effect of increase in heart rate after anthracycline chemotherapy on subsequent left ventricular dysfunction. J Cardiol 2024; 84:119-125. [PMID: 37949314 DOI: 10.1016/j.jjcc.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 11/01/2023] [Accepted: 11/01/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Anthracycline chemotherapy-related cardiac dysfunction is believed to be refractory to conventional pharmacological therapy and is associated with a poor prognosis. Increased heart rate (HR) is a known marker of cardiovascular outcomes for various categories of heart failure (HF). However, little interest has been expressed regarding increased HR after anthracycline chemotherapy. Aim of this study was to investigate the effect of increased HR soon after completion of anthracycline chemotherapy on subsequent left ventricular (LV) ejection fraction (LVEF) in cancer patients. METHODS We studied 172 patients with breast cancer and malignant lymphoma with preserved LVEF (≥ 50 %) and sinus rhythm treated with anthracyclines. Electrocardiography was performed before and soon after completion of anthracycline chemotherapy (2.3 months), and echocardiography before and late after completion of anthracycline chemotherapy (10.5 months). RESULTS HR significantly increased from 74.2 ± 14.2 bpm to 75.9 ± 13.2 bpm (P = 0.05) soon after completion of anthracycline chemotherapy, while LVEF subsequently significantly decreased from 65.3 ± 5.5 % to 62.4 ± 6.1 % (P < 0.01) late after completion of anthracycline chemotherapy. Patients whose HR increased ≥10 bpm subsequently showed a significantly greater decrease in LVEF than those whose HR increased <10 bpm [-4.9 % (-32.7 % - 10.8 %) vs. -2.2 % (-21.2 % - 12.9 %), p = 0.04]. Multivariable logistic regression analysis showed that an increase in HR soon after completion of anthracycline chemotherapy was independently associated with a subsequent decrease in LVEF (odds ratio: 1.022, 95 % confidential interval; 1.008-1.037, P = 0.002). CONCLUSIONS Our findings may have a novel effect on the management of cancer patients scheduled for anthracycline chemotherapy.
Collapse
Affiliation(s)
- Masayuki Kintsu
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Susumu Odajima
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kimikazu Takeuchi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yasushi Ichikawa
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Saki Todo
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Eri Ota
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yuki Yamauchi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroaki Shiraki
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kentaro Yamashita
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Terunobu Fukuda
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Eriko Hisamatsu
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hironobu Minami
- Division of Medical Oncology/Hematology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ken-Ichi Hirata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hidekazu Tanaka
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
| |
Collapse
|
2
|
Lim ZX, Gyanwali B, Soh J, Koh AS, Goh J. The potential benefits of assessing post-cardiopulmonary exercise testing (CPET) in aging: a narrative review. BMC Sports Sci Med Rehabil 2023; 15:68. [PMID: 37127789 PMCID: PMC10150471 DOI: 10.1186/s13102-023-00671-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 04/03/2023] [Indexed: 05/03/2023]
Abstract
Cardiopulmonary exercise testing (CPET) is an important tool to measure the cardiopulmonary fitness of an individual and has been widely used in athletic, clinical and research settings. Most CPET focus on analyzing physiological responses during exercise. We contend that the post-CPET recovery physiological responses offer further diagnostic and prognostic information about the health of the cardiopulmonary and metabolic systems, especially when testing apparently healthy middle-aged and older adults. However, there are limited studies that investigate physiological responses during the post-CPET recovery, and even less so in middle-aged and older adults. Therefore, this current review is aimed at discussing the contribution of post-CPET recovery parameters to cardiopulmonary health and their potential applications in aging populations. In addition to the existing methods, we propose to examine the aerobic and anaerobic recovery threshold post-CPET as novel potential diagnostic and/or prognostic tools.
Collapse
Affiliation(s)
- Zi Xiang Lim
- Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Queenstown, Singapore
- Centre for Healthy Longevity, National University Health System, Singapore, Singapore
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Queenstown, Singapore
| | - Bibek Gyanwali
- Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Queenstown, Singapore
- Centre for Healthy Longevity, National University Health System, Singapore, Singapore
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Queenstown, Singapore
| | - Janjira Soh
- Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Queenstown, Singapore
- Centre for Healthy Longevity, National University Health System, Singapore, Singapore
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Queenstown, Singapore
| | - Angela S Koh
- National Heart Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Jorming Goh
- Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Queenstown, Singapore.
- Centre for Healthy Longevity, National University Health System, Singapore, Singapore.
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Queenstown, Singapore.
| |
Collapse
|
3
|
Ristow B, Doubell A, Derman W, Heine M. Change in resting heart rate and risk for all-cause mortality. Eur J Prev Cardiol 2022; 29:e249-e254. [PMID: 34983058 DOI: 10.1093/eurjpc/zwab231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/28/2021] [Accepted: 12/31/2021] [Indexed: 11/14/2022]
Affiliation(s)
- Brandon Ristow
- Institute of Sport and Exercise Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University
| | - Anton Doubell
- Division of Cardiology, Department of Medicine, Faculty of Medicine and Health Sciences, University of Stellenbosch and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Wayne Derman
- Institute of Sport and Exercise Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University.,IOC Research Centre, Cape Town
| | - Martin Heine
- Institute of Sport and Exercise Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University
| |
Collapse
|
4
|
Cardiorespiratory Interaction and Autonomic Sleep Quality Improve during Sleep in Beds Made from Pinus cembra (Stone Pine) Solid Wood. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189749. [PMID: 34574675 PMCID: PMC8472742 DOI: 10.3390/ijerph18189749] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 09/02/2021] [Accepted: 09/08/2021] [Indexed: 12/27/2022]
Abstract
Cardiorespiratory interactions (CRIs) reflect the mutual tuning of two important organismic oscillators—the heartbeat and respiration. These interactions can be used as a powerful tool to characterize the self-organizational and recreational quality of sleep. In this randomized, blinded and cross-over design study, we investigated CRIs in 15 subjects over a total of 253 nights who slept in beds made from different materials. One type of bed, used as control, was made of melamine faced chipboard with a wood-like appearance, while the other type was made of solid wood from stone pine (Pinus cembra). We observed a significant increase of vagal activity (measured by respiratory sinus arrhythmia), a decrease in the heart rate (as an indicator of energy consumption during sleep) and an improvement in CRIs, especially during the first hours of sleep in the stone pine beds as compared to the chipboard beds. Subjective assessments of study participants’ well-being in the morning and sub-scalar assessments of their intrapsychic stability were significantly better after they slept in the stone pine bed than after they slept in the chipboard bed. Our observations suggest that CRIs are sensitive to detectable differences in indoor settings that are relevant to human health. Our results are in agreement with those of other studies that have reported that exposure to volatile phytochemical ingredients of stone pine (α-pinene, limonene, bornyl acetate) lead to an improvement in vagal activity and studies that show a reduction in stress parameters upon contact with solid wood surfaces.
Collapse
|
5
|
Subclinical cardiac damage in cancer patients before chemotherapy. Heart Fail Rev 2021; 27:1091-1104. [PMID: 34318387 PMCID: PMC9197815 DOI: 10.1007/s10741-021-10151-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/14/2021] [Indexed: 12/02/2022]
Abstract
Cancer and cardiovascular diseases, including heart failure (HF), are the main causes of death in Western countries. Several anticancer drugs and radiotherapy have adverse effects on the cardiovascular system, promoting left ventricular dysfunction and ultimately HF. Nonetheless, the relationship between cancer and HF is likely not unidirectional. Indeed, cancer and HF share common risk factors, and both have a bidirectional relationship with systemic inflammation, metabolic disturbances, and neurohormonal and immune activation. Few studies have assessed the impact of untreated cancer on the heart. The presence of an active cancer has been associated with elevated cardiac biomarkers, an initial impairment of left ventricular structure and function, autonomic dysfunction, and reduced exercise tolerance. In turn, these conditions might increase the risk of cardiac damage from chemotherapy and radiotherapy. HF drugs such as beta-blockers or inhibitors of the renin–angiotensin–aldosterone system might exert a protective effect on the heart even before the start of cancer therapies. In this review, we recapitulate the evidence of cardiac involvement in cancer patients naïve from chemotherapy and radiotherapy and no history of cardiac disease. We also focus on the perspectives for an early diagnosis and treatment to prevent the progression to cardiac dysfunction and clinical HF, and the potential benefits of cardioactive drugs on cancer progression.
Collapse
|
6
|
Park J, Han JS, Jo HJ, Kim HY, Yoon H, Shin CM, Park YS, Kim N, Lee DH. Resting heart rate is associated with colorectal advanced adenoma. PLoS One 2021; 16:e0254505. [PMID: 34242355 PMCID: PMC8270146 DOI: 10.1371/journal.pone.0254505] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 06/25/2021] [Indexed: 11/18/2022] Open
Abstract
Background and aims Resting heart rate is an independent predictor of colorectal cancer (CRC) development and CRC-related mortality. However, little is known about the relationship between resting heart rate and colorectal adenoma development. We aimed to investigate this association in a population who underwent screening colonoscopy. Methods Among 39,021 patients who underwent both electrocardiogram and screening colonoscopy during routine health examinations at the Seoul National University Bundang Hospital, Health Promotion Center, Korea from January 2014 to July 2019, 1,344 patients had advanced adenoma. We performed 1:1 propensity score (PS) matching to establish a control group that mitigated the confounding effects of age and sex. We performed multivariate logistic regression analyses to identify the independent risk factors of advanced adenoma development. Results Resting heart rate was significantly higher in the advanced adenoma group than in the control group. The prevalence of advanced polyp increased across the quartiles of resting heart rate. Patients with higher resting heart rates were more likely to be older, smokers, and have increased blood pressure and DM and less likely to engage in active exercises than those with lower resting heart rates. Patients with higher resting heart rates had higher serum glucose, triglyceride, hemoglobin A1C, and insulin levels and lower high-density lipoprotein cholesterol levels. Patients with resting heart rate in the highest quartile (≥71 bpm) still showed significantly increased odds ratio (OR) of advanced adenoma development (OR: 1.379, 95% confidence interval: 1.099–1.731, p = 0.006). Conclusions High resting heart rate was a meaningful independent risk factor of advanced adenoma development.
Collapse
Affiliation(s)
- Jihye Park
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Soo Han
- Health Promotion Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Hyun Jin Jo
- Health Promotion Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Hyun Young Kim
- Health Promotion Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Hyuk Yoon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Cheol Min Shin
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young Soo Park
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- * E-mail:
| | - Nayoung Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Dong Ho Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| |
Collapse
|
7
|
Heemelaar JC, Krol ADG, Louwerens M, L M A Beeres S, Holman ER, Schalij MJ, Louisa Antoni M. Elevated resting heart rate is a marker of subclinical left ventricular dysfunction in hodgkin lymphoma survivors. IJC HEART & VASCULATURE 2021; 35:100830. [PMID: 34258382 PMCID: PMC8253957 DOI: 10.1016/j.ijcha.2021.100830] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/16/2021] [Accepted: 06/17/2021] [Indexed: 01/08/2023]
Abstract
Background Thoracic irradiation is one of the cornerstones of Hodgkin lymphoma (HL) treatment, which contributes to high rates of long-term survivorship, but begets a life-long increased risk of heart disease including heart failure. At the cardio-oncology (CO) clinic, persistent sinus tachycardia or elevated resting heart rate (RHR) is frequently observed in these patients. The aim of this study was to evaluate the relation between RHR and left ventricular (LV) dysfunction. Methods In 75 HL survivors visiting our CO-clinic echocardiographic evaluation of LV systolic and diastolic function including global longitudinal strain (GLS) was performed to assess subclinical LV dysfunction. Results Median age of HL diagnosis was 24 [25th-75th percentile: [19], [29]] years with a 17 [12], [25] year interval to CO-clinic visit and 31 patients (41%) were male. Average RHR was 78 ± 14 bpm and 40% of patients (N = 30) had an elevated RHR defined as ≥ 80 bpm. While there was no difference in LV ejection fraction (55.6 ± 4.3 vs. 54.8 ± 6.6; p = 0.543), patients with elevated RHR had abnormal GLS (-15.9% vs. -18.3%, p = 0.045) and higher prevalence of diastolic dysfunction (73.3% vs. 46.7%; p = 0.022). GLS, E/e' ratio and presence of diastolic dysfunction were independently associated with RHR when correcting for age, sex and mantle field irradiation. A significant improvement was observed of the RHR-association model with solely extracardiac confounders when LV-function parameters were added to the model (F-statistic = 6.36, p = 0.003). Conclusions This study indicates RHR as a possible marker for subclinical LV-dysfunction in HL survivors.
Collapse
Affiliation(s)
- Julius C Heemelaar
- Department of Cardiology, Heart Lung Center, Leiden University Medical Centre, Leiden, the Netherlands
| | - Augustinus D G Krol
- Department of Radiotherapy, Leiden University Medical Centre, Leiden, the Netherlands
| | - Marloes Louwerens
- Department of Internal Medicine, Leiden University Medical Centre, Leiden, the Netherlands
| | - Saskia L M A Beeres
- Department of Cardiology, Heart Lung Center, Leiden University Medical Centre, Leiden, the Netherlands
| | - Eduard R Holman
- Department of Cardiology, Heart Lung Center, Leiden University Medical Centre, Leiden, the Netherlands
| | - Martin J Schalij
- Department of Cardiology, Heart Lung Center, Leiden University Medical Centre, Leiden, the Netherlands
| | - M Louisa Antoni
- Department of Cardiology, Heart Lung Center, Leiden University Medical Centre, Leiden, the Netherlands
| |
Collapse
|
8
|
Gutierrez-Martinez L, Brellenthin AG, Lefferts EC, Lee DC, Sui X, Lavie CJ, Blair SN. Resting Heart Rate and Risk of Cancer Mortality. Cancer Epidemiol Biomarkers Prev 2021; 30:1072-1078. [PMID: 33827985 PMCID: PMC8172441 DOI: 10.1158/1055-9965.epi-20-1731] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/16/2021] [Accepted: 03/26/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Increased resting heart rate (RHR) is a predictor of mortality. RHR is influenced by cardiorespiratory fitness (CRF). Little is known about the combined associations of RHR and CRF on cancer mortality. METHODS 50,108 men and women (mean age 43.8 years) were examined between 1974 and 2002 at the Cooper Clinic in Dallas, Texas. RHR was measured by electrocardiogram and categorized as <60, 60-69, 70-79, or ≥80 beats/minute. CRF was quantified by maximal treadmill test and dichotomized as unfit and fit corresponding to the lower 20% and the upper 80%, respectively, of the age- and sex-specific distribution of treadmill exercise duration. The National Death Index was used to ascertain vital status. Cox regression was used to compute HRs and 95% confidence intervals (CI) for cancer mortality across RHR categories. RESULTS During a mean follow-up of 15.0 ± 8.6 years, 1,090 cancer deaths occurred. Compared with RHR <60 beats/minute, individuals with RHR ≥80 beats/minute had a 35% increased risk of overall cancer mortality (HR, 1.35; 95% CI, 1.06-1.71) after adjusting for confounders, including CRF. Compared with "fit and RHR <80 beats/minute", HRs (95% CI) for cancer mortality were 1.41 (1.20-1.66), 1.51 (1.11-2.04), and 1.78 (1.30-2.43) in "unfit and RHR <80," "fit and RHR ≥80," and "unfit and RHR ≥80 beats/minute," respectively. CONCLUSIONS RHR ≥80 beats/minute is associated with an increased risk of overall cancer mortality. High CRF may help lower the risk of cancer mortality among those with high RHR. IMPACT RHR along with CRF may provide informative data about an individual's cancer mortality risk.
Collapse
Affiliation(s)
| | | | | | - Duck-Chul Lee
- Department of Kinesiology, Iowa State University, Ames, Iowa
| | - Xuemei Sui
- Department of Exercise Science, University of South Carolina, Columbia, South Carolina
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, Louisiana
| | - Steven N Blair
- Department of Exercise Science, University of South Carolina, Columbia, South Carolina
| |
Collapse
|
9
|
Pozuelo-Carrascosa DP, Cavero-Redondo I, Lee I, Álvarez-Bueno C, Reina-Gutierrez S, Martínez-Vizcaíno V. Resting Heart Rate as a Predictor of Cancer Mortality: A Systematic Review and Meta-Analysis. J Clin Med 2021; 10:1354. [PMID: 33806038 PMCID: PMC8037294 DOI: 10.3390/jcm10071354] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/18/2021] [Accepted: 03/20/2021] [Indexed: 12/12/2022] Open
Abstract
This work was aimed to synthetize the evidence available about the relationship between resting heart rate (RHR) and the risk of cancer mortality. A computerized search in the Medline, EMBASE, Web of Science, and Cochrane Library databases from their inception to 24 September 2020 was performed. We performed three meta-analyses: (1) cancer mortality comparing the "less than 60 bpm" and "more than 60 bpm" categories; (2) cancer mortality comparing "less than 60 bpm", "60 to 80 bpm", and "more than 80 bpm" categories; and (3) analysis for 10-12 and 20 bpm increase in RHR and risk of cancer mortality. Twenty-two studies were included in the qualitative review, and twelve of them met the inclusion criteria for the meta-analysis. Our results showed a positive association between RHR and the risk of cancer mortality. This association was shown in a meta-analysis comparing studies reporting mean RHR values below and above 60 bpm, when comparing three RHR categories using less than 60 bpm as the reference category and, finally, in dose response analyses estimating the effect of an increase of 10-12 bpm in RHR, both in men and in women. In conclusion, a low RHR is a potential marker of low risk of cancer mortality.
Collapse
Affiliation(s)
- Diana P. Pozuelo-Carrascosa
- Health and Social Care Research Center, Universidad de Castilla-La Mancha, 16071 Cuenca, Spain; (D.P.P.-C.); (C.Á.-B.); (S.R.-G.); (V.M.-V.)
- Faculty of Physiotherapy and Nursing, Universidad de Castilla-La Mancha, 45004 Toledo, Spain
| | - Iván Cavero-Redondo
- Health and Social Care Research Center, Universidad de Castilla-La Mancha, 16071 Cuenca, Spain; (D.P.P.-C.); (C.Á.-B.); (S.R.-G.); (V.M.-V.)
- Rehabilitation in Health Research Center (CIRES), Universidad de las Americas, Echaurren Street 140, 2nd Floor, 72819 Santiago, Chile
| | - I.M. Lee
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA;
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Celia Álvarez-Bueno
- Health and Social Care Research Center, Universidad de Castilla-La Mancha, 16071 Cuenca, Spain; (D.P.P.-C.); (C.Á.-B.); (S.R.-G.); (V.M.-V.)
- Universidad Politécnica y Artística del Paraguay, Asunción 001518, Paraguay
| | - Sara Reina-Gutierrez
- Health and Social Care Research Center, Universidad de Castilla-La Mancha, 16071 Cuenca, Spain; (D.P.P.-C.); (C.Á.-B.); (S.R.-G.); (V.M.-V.)
| | - Vicente Martínez-Vizcaíno
- Health and Social Care Research Center, Universidad de Castilla-La Mancha, 16071 Cuenca, Spain; (D.P.P.-C.); (C.Á.-B.); (S.R.-G.); (V.M.-V.)
- Faculty of Health Sciences, Universidad Autónoma de Chile, 1670 Talca, Chile
| |
Collapse
|
10
|
Association of clinic and ambulatory heart rate parameters with mortality in hypertension. J Hypertens 2020; 38:2416-2426. [DOI: 10.1097/hjh.0000000000002565] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
11
|
Abstract
Heart rate is a parameter that is very easy to measure and is widely used both in clinic and during daily life activities. Its value gained more relevance with the evidence, in prospective studies and meta-analysis, of association between elevated heart rate values and diseases and outcomes.The increased knowledge of physiological mechanisms of heart rate control and the pathophysiological mechanisms responsible for its dysfunction allows to identify the cut-off value of normalcy providing info for non-pharmacological and pharmacological treatments to reduce the cardiovascular risk both in general population and in pathophysiological conditions. This paper overviews the knowledges of the role of resting heart rate as predictor of cardiovascular risk.
Collapse
Affiliation(s)
- Gino Seravalle
- Department of Cardiology, Italian Auxological Institute S. Luca Hospital, Milan, Italy -
| | | | - Guido Grassi
- Department of Health Science, Milano-Bicocca University, Milan, Italy
| |
Collapse
|
12
|
Anker MS, Frey MK, Goliasch G, Bartko PE, Prausmüller S, Gisslinger H, Kornek G, Strunk G, Raderer M, Zielinski C, Hülsmann M, Pavo N. Increased resting heart rate and prognosis in treatment-naïve unselected cancer patients: results from a prospective observational study. Eur J Heart Fail 2020; 22:1230-1238. [PMID: 32202022 PMCID: PMC7540544 DOI: 10.1002/ejhf.1782] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 02/21/2020] [Accepted: 02/16/2020] [Indexed: 12/19/2022] Open
Abstract
Aims Cancer patients suffer from impaired cardiovascular function. Elevated resting heart rate (RHR) has been identified as a marker for increased long‐term mortality in cancer patients prior to the receipt of anticancer treatment. We aimed to establish whether RHR is associated with survival in treatment‐naïve cancer patients. Methods and results This prospective study enrolled 548 unselected treatment‐naïve cancer patients between 2011 and 2013. The median age of the cohort was 62 years; 40.9% were male and 32.7% had metastatic disease. Median RHR was 72 b.p.m. Most patients were in sinus rhythm (n = 507, 92.5%). Clinical heart failure was noted in 37 (6.8%) patients. RHR was not related to cancer stage (P = 0.504). Patients in the highest RHR tertile had higher levels of high‐sensitivity troponin (P = 0.003) and N‐terminal pro‐B‐type natriuretic peptide (P = 0.039). During a median follow‐up of 25 months (interquartile range: 16–32 months; range: 0–40 months), 185 (33.8%) patients died from any cause [1‐year‐mortality: 17%, 95% confidence interval (CI) 13–20%]. In univariate survival analysis, RHR predicted all‐cause mortality [crude hazard ratio (HR) for a 5 b.p.m. increase in RHR: 1.09, 95% CI 1.04–1.15; P < 0.001], and remained significantly associated with outcome after adjustment for age, gender, tumour entity, tumour stage, cardiac status and haemoglobin (adjusted HR for a 5 b.p.m. increase in RHR: 1.10, 95% CI 1.04–1.16; P < 0.001). There was no significant impact of metastatic/non‐metastatic disease state on the predictive value of RHR (P = 0.433 for interaction). In subgroup analyses, the strongest associations for RHR with mortality were observed in lung (crude HR 1.14; P = 0.007) and gastrointestinal (crude HR 1.31; P < 0.001) cancer. Conclusions Treatment‐naïve cancer patients with higher RHRs display higher levels of cardiovascular biomarkers. RHR was independently associated with all‐cause mortality, especially in lung and gastrointestinal cancers. Elevated RHR and cardiovascular biomarkers may represent early signs of incipient cardiac dysfunction.
Collapse
Affiliation(s)
- Markus S Anker
- Department of Cardiology & Berlin Institute of Health Center for Regenerative Therapies (BCRT), German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Charité-Universitätsmedizin Berlin (Campus CVK), Berlin, Germany.,Department of Cardiology, Charité Universitätsmedizin Berlin (Campus CBF), Berlin, Germany
| | - Maria K Frey
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Georg Goliasch
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Philipp E Bartko
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Suriya Prausmüller
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Heinz Gisslinger
- Department of Internal Medicine I, Clinical Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Gabriela Kornek
- Department of Internal Medicine I, Clinical Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Guido Strunk
- Department of Complexity Research, Complexity Science Hub, Vienna, Austria.,Department of Integrated Safety and Security, University of Applied Sciences, FH Campus Vienna, Vienna, Austria.,Department of Entrepreneurship and Economic Education, Faculty of Business and Economics, Technical University Dortmund, Dortmund, Germany
| | - Markus Raderer
- Department of Internal Medicine I, Clinical Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Christoph Zielinski
- Department of Internal Medicine I, Clinical Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Martin Hülsmann
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Noemi Pavo
- Department of Internal Medicine II, Clinical Division of Cardiology, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
13
|
Association between Resting Heart Rate and Colorectal Cancer: Results from a Case-Controlled Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16162883. [PMID: 31409045 PMCID: PMC6719185 DOI: 10.3390/ijerph16162883] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 08/05/2019] [Accepted: 08/07/2019] [Indexed: 01/11/2023]
Abstract
Previous studies evaluating associations between resting heart rate (RHR) and cancer-related mortality/prognosis have yielded conflicting results. We investigated whether elevations in RHR are associated with colorectal cancer (CRC). We conducted a case-controlled study involving 1241 CRC patients and 5909 cancer-free controls from the Korean National Health and Nutrition Examination Survey. After propensity score (PS) matching, 1207 CRC patients and 1207 matched controls were analyzed. Associations between RHR and CRC, colon, and rectal cancer were analyzed in appropriate patient subgroups using multiple and conditional logistic regression. Receiver operating characteristics analysis yielded the optimal RHR cut-point to predict CRC. RHR was significantly higher in CRC, colon, and rectal cancer patients than in controls (72.7 bpm in CRC, 72.8 bpm in colon cancer, 72.3 bpm in rectal cancer, and 68.7 bpm in controls; all p < 0.001). Analysis of data prior to PS matching yielded the following odds ratios (ORs) per RHR increment for CRC, colon, and rectal cancer: 1.043 (95% confidence intervals (CIs): 1.036–1.049), 1.045 (95% CI: 1.037–1.053), and 1.040 (95% CI: 1.030–1.051), respectively, in unadjusted models, and 1.043 (95% CI: 1.034–1.051), 1.046 (95% CI: 1.037–1.055), and 1.040 (95% CI: 1.027–1.052), respectively, in multivariable adjusted models. Patients with CRC, colon, and rectal cancer have a significantly higher RHR compared to cancer-free controls.
Collapse
|
14
|
De Silva SF, Alcorn J. Flaxseed Lignans as Important Dietary Polyphenols for Cancer Prevention and Treatment: Chemistry, Pharmacokinetics, and Molecular Targets. Pharmaceuticals (Basel) 2019; 12:E68. [PMID: 31060335 PMCID: PMC6630319 DOI: 10.3390/ph12020068] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 04/26/2019] [Accepted: 04/30/2019] [Indexed: 02/07/2023] Open
Abstract
Cancer causes considerable morbidity and mortality across the world. Socioeconomic, environmental, and lifestyle factors contribute to the increasing cancer prevalence, bespeaking a need for effective prevention and treatment strategies. Phytochemicals like plant polyphenols are generally considered to have anticancer, anti-inflammatory, antiviral, antimicrobial, and immunomodulatory effects, which explain their promotion for human health. The past several decades have contributed to a growing evidence base in the literature that demonstrate ability of polyphenols to modulate multiple targets of carcinogenesis linking models of cancer characteristics (i.e., hallmarks and nutraceutical-based targeting of cancer) via direct or indirect interaction or modulation of cellular and molecular targets. This evidence is particularly relevant for the lignans, an ubiquitous, important class of dietary polyphenols present in high levels in food sources such as flaxseed. Literature evidence on lignans suggests potential benefit in cancer prevention and treatment. This review summarizes the relevant chemical and pharmacokinetic properties of dietary polyphenols and specifically focuses on the biological targets of flaxseed lignans. The consolidation of the considerable body of data on the diverse targets of the lignans will aid continued research into their potential for use in combination with other cancer chemotherapies, utilizing flaxseed lignan-enriched natural products.
Collapse
Affiliation(s)
- S Franklyn De Silva
- Drug Discovery & Development Research Group, College of Pharmacy and Nutrition, 104 Clinic Place, Health Sciences Building, University of Saskatchewan, Saskatoon, Saskatchewan (SK), S7N 2Z4, Canada.
| | - Jane Alcorn
- Drug Discovery & Development Research Group, College of Pharmacy and Nutrition, 104 Clinic Place, Health Sciences Building, University of Saskatchewan, Saskatoon, Saskatchewan (SK), S7N 2Z4, Canada.
| |
Collapse
|
15
|
Sarocchi M, Arboscello E, Ghigliotti G, Murialdo R, Bighin C, Gualandi F, Sicbaldi V, Balbi M, Brunelli C, Spallarossa P. Ivabradine in Cancer Treatment-Related Left Ventricular Dysfunction. Chemotherapy 2019; 63:315-320. [PMID: 30840967 DOI: 10.1159/000495576] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 11/19/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Patients developing cancer treatment-related left ventricular dysfunction (CTrLVD) require a prompt therapy. Hypotension, dizziness, and fatigue often limit the use of angiotensin-converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARB), and β-blockers (BB) in cancer patients who may already be afflicted by these symptoms. Ivabradine is a heart rate-lowering drug that does not cause hypotension and may be used in heart failure with reduced left ventricular ejection fraction (LVEF). OBJECTIVE The aim of this paper was to investigate the role of ivabradine to treat CTrLVD. METHODS A retrospective analysis in a cohort of 30 patients with CTrLVD (LVEF < 50%) receiving ivabradine on top of the maximal tolerated dose of ACEi/ARB and BB was performed. We evaluated cardiovascular treatment, oncologic treatment, LVEF, functional class (New York Heart Association [NYHA]), and fatigue during the study period. RESULTS Ivabradine was initially started at the dose of 2.5 mg/b.i.d. in most patients and then carefully titrated. Hypotension (70%) and fatigue (77%) were the main causes limiting the treatment with ACEi/ARB and BB. After a mean follow-up of 6.5 months, LVEF increased from 45.1% (SD = 6.4) to 53.2% (SD = 3.9; p < 0.001). When patients were analyzed according to the type of cancer therapy, no difference in LVEF changes across the groups was found. NYHA class ameliorated in 11 patients, while fatigue improved in 8 patients. No serious cardiovascular side effects were reported. CONCLUSIONS The ability to improve symptoms and LVEF in unfit cancer patients makes ivabradine a reasonable pharmacological tool for treating CTrLVD.
Collapse
Affiliation(s)
- Matteo Sarocchi
- Cardiovascular Disease Unit, San Martino Policlinic Hospital, Genoa, Italy.,Department of Internal Medicine, University of Genoa, Genoa, Italy
| | | | - Giorgio Ghigliotti
- Cardiovascular Disease Unit, San Martino Policlinic Hospital, Genoa, Italy.,Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Roberto Murialdo
- Internal Medicine Unit, San Martino Policlinic Hospital, Genoa, Italy
| | - Claudia Bighin
- Medical Oncology Unit, San Martino Policlinic Hospital, Genoa, Italy
| | | | - Vera Sicbaldi
- Internal Medicine Unit, San Martino Policlinic Hospital, Genoa, Italy
| | - Manrico Balbi
- Cardiovascular Disease Unit, San Martino Policlinic Hospital, Genoa, Italy.,Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Claudio Brunelli
- Cardiovascular Disease Unit, San Martino Policlinic Hospital, Genoa, Italy.,Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Paolo Spallarossa
- Cardiovascular Disease Unit, San Martino Policlinic Hospital, Genoa, Italy,
| |
Collapse
|
16
|
Jensen MT. Resting heart rate and relation to disease and longevity: past, present and future. Scandinavian Journal of Clinical and Laboratory Investigation 2019; 79:108-116. [PMID: 30761923 DOI: 10.1080/00365513.2019.1566567] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Assessment of heart rate has been used for millennia as a marker of health. Several studies have indicated that low resting heart rate (RHR) is associated with health and longevity, and conversely, a high resting heart to be associated with disease and adverse events. Longitudinal studies have shown a clear association between increase in heart rate over time and adverse events. RHR is a fundamental clinical characteristic and several trials have assessed the effectiveness of heart rate lowering medication, for instance beta-blockers and selective sinus node inhibition. Advances in technology have provided new insights into genetic factors related to RHR as well as insights into whether elevated RHR is a risk factor or risk marker. Recent animal research has suggested that heart rate lowering with sinus node inhibition is associated with increased lifespan. Furthermore, genome-wide association studies in the general population using Mendelian randomization have demonstrated a causal link between heart rate at rest and longevity. Furthermore, the development in personal digital devices such as mobile phones, fitness trackers and eHealth applications has made heart rate information and knowledge in this field as important as ever for the public as well as the clinicians. It should therefore be expected that clinicians and health care providers will be met by relevant questions and need of advice regarding heart rate information from patients and the public. The present review provides an overview of the current knowledge in the field of heart rate and health.
Collapse
Affiliation(s)
- Magnus T Jensen
- a Department of Cardiology , Rigshospitalet , Copenhagen, Denmark.,b Department of Cardiology , Herlev-Gentofte Hospital , Hellerup , Denmark
| |
Collapse
|
17
|
Chistyakova MV, Goncharova EV. Early diagnosis of cardiotoxic complications of chemotherapy: the possibility of radiation research methods. ACTA ACUST UNITED AC 2018; 58:11-17. [PMID: 30625104 DOI: 10.18087/cardio.2512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 12/26/2018] [Indexed: 11/18/2022]
Abstract
Oncological diseases are the main causes of death in the world. Modern treatment of cancer patients contributes to an increase in survival rate due to strong chemotherapeutic drugs, the use of which is accompanied by toxic effects on cardiomyocytes. The main manifestations of cardiotoxicity are left ventricular dysfunction, myocardial ischemia, thromboembolic complications, chronic heart failure. As a result, the risk of cardiovascular mortality may be higher than the risk of death from the tumor process. An important task of oncologists and cardiologists is the early diagnosis of cardiotoxic complications in order to start treatment in time and reduce mortality from cardiovascular pathology in cancer patients.
Collapse
|
18
|
Lee MK, Lee DH, Park S, Kim SI, Jeon JY. Relationship between resting heart rate and metabolic risk factors in breast cancer patients. Clin Chim Acta 2018; 486:104-109. [PMID: 30030991 DOI: 10.1016/j.cca.2018.07.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 07/05/2018] [Accepted: 07/17/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Higher resting heart rate (RHR) was associated with poor prognosis in breast cancer survivors, but the mechanism underlying such association has not been fully studied. We investigated the association between RHR and metabolic risk factors in stage I-III breast cancer survivors. METHODS Among 11,013 women diagnosed with breast cancer between 2005 and 2013 at the Severance hospital in Seoul, Korea, a total of 4980 patients met our inclusion criteria for the final analysis. Multivariable linear regressions were used to examine the association between RHR and metabolic risk factors, including systolic blood pressure (SBP), diastolic blood pressure (DBP), glucose, triglyceride (TG), total cholesterol, high density lipid cholesterol (HDLC), and low density lipid cholesterol. RESULTS The results showed that RHR had significant linear associations with SBP (p = .02), DBP (p < .001), TG (p < .001), glucose (p < .001), and HDL-C (p < .001). Compared to participants in the lowest quintile of RHR (<68 beat per min (bpm)), participants in the highest quintile (≥85 bpm) had higher DBP by 4 mmHg, TG by 13 mg/dl, and glucose by 5 mg/dl after adjusting for potential confounders. Further subgroup analyses showed that the association of RHR may differ by age and menopausal status for fasting glucose and cancer stage, chemotherapy, estrogen and progesterone receptor status for TG. CONCLUSIONS We observed a strong positive association of RHR with fasting glucose, TG, and DBP in breast cancer survivors, which may potentially explain the association between RHR and breast cancer prognosis.
Collapse
Affiliation(s)
- Mi Kyung Lee
- Department of Sport Industry Studies, Exercise Medicine and Rehabilitation Laboratory, Yonsei University, Seoul, Republic of Korea; Exercise Medicine Center for Diabetes and Cancer Patients, ICONS, Yonsei University College of Medicine, Seoul, Republic of Korea; Cancer Prevention Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dong Hoon Lee
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Seho Park
- Department of Surgery, Yonsei University College of Medicine, 50 Yonsei-Ro, Seodaemun-Gu, Seoul, 120-752, Republic Korea.
| | - Seung Il Kim
- Department of Surgery, Yonsei University College of Medicine, 50 Yonsei-Ro, Seodaemun-Gu, Seoul, 120-752, Republic Korea
| | - Justin Y Jeon
- Department of Sport Industry Studies, Exercise Medicine and Rehabilitation Laboratory, Yonsei University, Seoul, Republic of Korea; Exercise Medicine Center for Diabetes and Cancer Patients, ICONS, Yonsei University College of Medicine, Seoul, Republic of Korea; Cancer Prevention Center, Yonsei University College of Medicine, Seoul, Republic of Korea.
| |
Collapse
|
19
|
van de Vegte YJ, van der Harst P, Verweij N. Heart Rate Recovery 10 Seconds After Cessation of Exercise Predicts Death. J Am Heart Assoc 2018; 7:JAHA.117.008341. [PMID: 29622586 PMCID: PMC6015434 DOI: 10.1161/jaha.117.008341] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Heart rate recovery (HRR) is commonly defined as the decrease of heart rate at 1 minute after cessation of exercise and is an important predictor of all-cause mortality and death associated with coronary artery disease. However, HRR at earlier time intervals after cessation has not been well evaluated and might better reflect PNS reactivation. We hypothesize that early HRR indices within the first minute is better associated with all-cause and coronary artery disease mortality compared with HRR at 1 minute. METHODS AND RESULTS The prognostic value of HRR at 10, 20, 30, 40, and 50 seconds after cessation of exercise was investigated in 40 727 selected UK Biobank participants (mean age 56 years, 45% male) free from cardiovascular disease. During a median follow-up period of 6 years, 536 participants died (including 39 of coronary artery disease). In multivariable analyses, including adjustments for aerobic exercise capacity, cardiovascular risk factors, and factors associated with mortality in general, only HRR at 10 seconds remained predictive of both all-cause and coronary artery disease mortality. Effects of HRR were larger and more significant when measured early after exercise cessation. Moreover, the association of change in heart rate between 10 seconds and 1 minute after exercise cessation with mortality was dependent on HRR at 10 seconds. CONCLUSIONS We provide evidence that decreased HRR at 10 seconds after cessation of exercise is a superior predictor of outcome compared with HRR at later time intervals. This observation might have important implications for the future reporting and interpretation of exercise tests.
Collapse
Affiliation(s)
- Yordi J van de Vegte
- Department of Cardiology, University of Groningen University Medical Center Groningen, Groningen, the Netherlands
| | - Pim van der Harst
- Department of Cardiology, University of Groningen University Medical Center Groningen, Groningen, the Netherlands.,Department of Genetics, University of Groningen University Medical Center Groningen, Groningen, the Netherlands.,Durrer Center for Cardiogenetic Research, Netherlands Heart Institute, Utrecht, the Netherlands
| | - Niek Verweij
- Department of Cardiology, University of Groningen University Medical Center Groningen, Groningen, the Netherlands
| |
Collapse
|
20
|
Tadic M, Cuspidi C, Grassi G. Heart rate as a predictor of cardiovascular risk. Eur J Clin Invest 2018; 48. [PMID: 29355923 DOI: 10.1111/eci.12892] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 01/16/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Heart rate (HR) is a predictor of cardiovascular, cerebrovascular and all-cause mortality in the general population, as well as in patients with cardio- and cerebrovascular diseases. We aimed to summarize current knowledge regarding the influence of HR on cardio- and cerebrovascular morbidity and mortality. MATERIALS AND METHODS PubMed, MEDLINE, Ovid and EMBASE databases were searched for large follow-up studies or meta-analysis published between January 1990 and September 2017 in the English language using the following keyword "heart rate," "resting heart rate," "mortality," "outcome," "hypertension," "heart failure," "ischaemic heart disease," "coronary heart disease" and "stroke." RESULTS The relationship between increased HR and cardio- and cerebrovascular morbidity and mortality has been reported in a large number of studies, and the results regarding this association are concurrent. This connection is generally stronger in men than in women. The increase in HR usually occurs in parallel with elevation of blood pressure and metabolic disturbances (insulin resistance, dyslipidaemia). However, even after adjustment for the most important cardiovascular risk factors, HR remained an independent predictor of adverse events in global population or in patients with cardio- and cerebrovascular diseases. CONCLUSION HR has an important negative effect on cardio- and cerebrovascular morbidity and mortality. Future longitudinal investigations should clarify HR significance and optimal HR reduction for primary and secondary prevention in cardio- and cerebrovascular events.
Collapse
Affiliation(s)
- Marijana Tadic
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Cesare Cuspidi
- Clinical Research Unit, University of Milan-Bicocca and Istituto Auxologico Italiano, Meda, Italy
| | - Guido Grassi
- Department of Health Science, University of Milano-Bicocca, Milano, Italy.,IRCCS Multimedica, Sesto San Giovanni, Milano, Italy
| |
Collapse
|
21
|
Genetic study links components of the autonomous nervous system to heart-rate profile during exercise. Nat Commun 2018; 9:898. [PMID: 29497042 PMCID: PMC5832790 DOI: 10.1038/s41467-018-03395-6] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 02/09/2018] [Indexed: 01/01/2023] Open
Abstract
Heart rate (HR) responds to exercise by increasing during exercise and recovering after exercise. As such, HR is an important predictor of mortality that researchers believe is modulated by the autonomic nervous system. However, the mechanistic basis underlying inter-individual differences has yet to be explained. Here, we perform a large-scale genome-wide analysis of HR increase and HR recovery in 58,818 UK Biobank individuals. Twenty-five independent SNPs in 23 loci are identified to be associated (p < 8.3 × 10−9) with HR increase or HR recovery. A total of 36 candidate causal genes are prioritized that are enriched for pathways related to neuron biology. No evidence is found of a causal relationship with mortality or cardiovascular diseases. However, a nominal association with parental lifespan requires further study. In conclusion, the findings provide new biological and clinical insight into the mechanistic underpinnings of HR response to exercise. The results also underscore the role of the autonomous nervous system in HR recovery. Response of the heart rate (HR) to exercise is associated with cardiac fitness and risk of cardiac death. Here, in a genome-wide association study, Verweij et al. identify 23 loci for HR increase during exercise or HR recovery, and highlight pleiotropy with blood pressure by polygenic risk score analysis.
Collapse
|
22
|
Tu H, Wen CP, Tsai SP, Chow WH, Wen C, Ye Y, Zhao H, Tsai MK, Huang M, Dinney CP, Tsao CK, Wu X. Cancer risk associated with chronic diseases and disease markers: prospective cohort study. BMJ 2018; 360:k134. [PMID: 29386192 PMCID: PMC5791146 DOI: 10.1136/bmj.k134] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/11/2017] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To assess the independent and joint associations of major chronic diseases and disease markers with cancer risk and to explore the benefit of physical activity in reducing the cancer risk associated with chronic diseases and disease markers. DESIGN Prospective cohort study. SETTING Standard medical screening program in Taiwan. PARTICIPANTS 405 878 participants, for whom cardiovascular disease markers (blood pressure, total cholesterol, and heart rate), diabetes, chronic kidney disease markers (proteinuria and glomerular filtration rate), pulmonary disease, and gouty arthritis marker (uric acid) were measured or diagnosed according to standard methods, were followed for an average of 8.7 years. MAIN OUTCOME MEASURES Cancer incidence and cancer mortality. RESULTS A statistically significantly increased risk of incident cancer was observed for the eight diseases and markers individually (except blood pressure and pulmonary disease), with adjusted hazard ratios ranging from 1.07 to 1.44. All eight diseases and markers were statistically significantly associated with risk of cancer death, with adjusted hazard ratios ranging from 1.12 to 1.70. Chronic disease risk scores summarizing the eight diseases and markers were positively associated with cancer risk in a dose-response manner, with the highest scores associated with a 2.21-fold (95% confidence interval 1.77-fold to 2.75-fold) and 4.00-fold (2.84-fold to 5.63-fold) higher cancer incidence and cancer mortality, respectively. High chronic disease risk scores were associated with substantial years of life lost, and the highest scores were associated with 13.3 years of life lost in men and 15.9 years of life lost in women. The population attributable fractions of cancer incidence or cancer mortality from the eight chronic diseases and markers together were comparable to those from five major lifestyle factors combined (cancer incidence: 20.5% v 24.8%; cancer mortality: 38.9% v 39.7%). Among physically active (versus inactive) participants, the increased cancer risk associated with chronic diseases and markers was attenuated by 48% for cancer incidence and 27% for cancer mortality. CONCLUSIONS Chronic disease is an overlooked risk factor for cancer, as important as five major lifestyle factors combined. In this study, chronic diseases contributed to more than one fifth of the risk for incident cancer and more than one third of the risk for cancer death. Physical activity is associated with a nearly 40% reduction in the cancer risk associated with chronic diseases.
Collapse
Affiliation(s)
- Huakang Tu
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Chi Pang Wen
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
- Graduate Institute of Biomedical Sciences, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | | | - Wong-Ho Chow
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Christopher Wen
- Radiology, Long Beach Veterans Administration Hospital, University of California at Irvine, CA, USA
| | - Yuanqing Ye
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Hua Zhao
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Min Kuang Tsai
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - Maosheng Huang
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Colin P Dinney
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Xifeng Wu
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| |
Collapse
|
23
|
Seviiri M, Lynch BM, Hodge AM, Yang Y, Liew D, English DR, Giles GG, Milne RL, Dugué PA. Resting heart rate, temporal changes in resting heart rate, and overall and cause-specific mortality. Heart 2017; 104:1076-1085. [PMID: 29269380 DOI: 10.1136/heartjnl-2017-312251] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 11/14/2017] [Accepted: 11/16/2017] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Most studies investigating the association between resting heart rate (RHR) and mortality have focused on cardiovascular disease (CVD) mortality, and measured RHR at only one time point. We aimed to assess associations of RHR and changes in RHR over approximately a decade with overall and cause-specific mortality. METHODS We used data from participants in the Melbourne Collaborative Cohort Study with RHR measures at baseline (1990-1994; n=41 386; 9846 deaths) and at follow-up (2003-2007; n=21 692; 2818 deaths). RHR measures were taken by trained staff, using Dinamap monitors. Cox models were used to estimate HR and 95% CI for the associations between RHR and mortality. Vital status and cause of death were ascertained until August 2015 and December 2013, respectively. RESULTS After adjustment for confounders, including blood pressure and known medical conditions but not arrhythmias or atrial fibrillation, RHR was associated with a higher risk of death of similar magnitude for CVD (HR per 10 beats per minute (bpm)=1.11, 95% CI 1.07 to 1.16), cancer (HR=1.10, 95% CI 1.06 to 1.13) and other causes (HR=1.20, 95% CI 1.16 to 1.25). Higher mortality was observed for most cancer sites, including breast (HR=1.16, 95% CI 1.03 to 1.31), colorectal (HR=1.18, 95% CI 1.08 to 1.29), kidney (HR=1.27, 95% CI 1.03 to 1.57) and lung cancer (HR=1.19, 95% CI 1.10 to 1.29). Temporal increases in RHR were associated with higher mortality, particularly for individuals whose RHR increased by more than 15 bpm. CONCLUSIONS RHR and changes in RHR over a decade are associated with mortality risk, including from causes other than CVD such as breast, colorectal or lung cancer. Monitoring of RHR may have utility in identifying individuals at higher mortality risk.
Collapse
Affiliation(s)
- Mathias Seviiri
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Brigid M Lynch
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Victoria, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.,Physical Activity Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Allison M Hodge
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Victoria, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Yi Yang
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Victoria, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Dallas R English
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Victoria, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Graham G Giles
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Victoria, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Roger L Milne
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Victoria, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Pierre-Antoine Dugué
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Victoria, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
24
|
Nikolovska Vukadinović A, Vukadinović D, Borer J, Cowie M, Komajda M, Lainscak M, Swedberg K, Böhm M. Heart rate and its reduction in chronic heart failure and beyond. Eur J Heart Fail 2017. [DOI: 10.1002/ejhf.902] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
| | - Davor Vukadinović
- Klinik für Innere Medizin III; der Universität des Saarlandes; Homburg/Saar Germany
| | - Jeffrey Borer
- Division of Cardiovascular Medicine and the Howard Gilman Institute for Heart Valve Disease and the Schiavone Institute for Cardiovascular Translational Research; State University of New York Downstate Medical Center; New York NY USA
| | | | | | - Mitja Lainscak
- Department of Cardiology, Department of Research and Education; Celje Slovenia
| | - Karl Swedberg
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy; University of Gothenburg; Göteborg Sweden
| | - Michael Böhm
- Klinik für Innere Medizin III; der Universität des Saarlandes; Homburg/Saar Germany
| |
Collapse
|
25
|
Aune D, Sen A, ó'Hartaigh B, Janszky I, Romundstad PR, Tonstad S, Vatten LJ. Resting heart rate and the risk of cardiovascular disease, total cancer, and all-cause mortality - A systematic review and dose-response meta-analysis of prospective studies. Nutr Metab Cardiovasc Dis 2017; 27:504-517. [PMID: 28552551 DOI: 10.1016/j.numecd.2017.04.004] [Citation(s) in RCA: 156] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 04/06/2017] [Accepted: 04/13/2017] [Indexed: 01/16/2023]
Abstract
BACKGROUND AND AIM Epidemiological studies have reported increased risk of cardiovascular disease, cancer and all-cause mortality with greater resting heart rate, however, the evidence is not consistent. Differences by gender, adjustment for confounding factors, as well as the potential impact of subclinical disease are not clear. A previous meta-analysis missed a large number of studies, and data for atrial fibrillation have not been summarized before. We therefore aimed to clarify these associations in a systematic review and meta-analysis of prospective studies. METHODS AND RESULTS PubMed and Embase were searched up to 29 March 2017. Summary RRs and 95% confidence intervals (CIs) were calculated using random effects models. Eighty seven studies were included. The summary RR per 10 beats per minute increase in resting heart rate was 1.07 (95% CI: 1.05-1.10, I2 = 61.9%, n = 31) for coronary heart disease, 1.09 (95% CI: 1.00-1.18, I2 = 62.3%, n = 5) for sudden cardiac death, 1.18 (95% CI: 1.10-1.27, I2 = 74.5%, n = 8) for heart failure, 0.97 (95% CI: 0.92-1.02, I2 = 91.4%, n = 9) for atrial fibrillation, 1.06 (95% CI: 1.02-1.10, I2 = 59.5%, n = 16) for total stroke, 1.15 (95% CI: 1.11-1.18, I2 = 84.3%, n = 35) for cardiovascular disease, 1.14 (95% CI: 1.06-1.23, I2 = 90.2%, n = 12) for total cancer, and 1.17 (95% CI: 1.14-1.19, I2 = 94.0%, n = 48) for all-cause mortality. There was a positive dose-response relationship for all outcomes except for atrial fibrillation for which there was a J-shaped association. CONCLUSION This meta-analysis found an increased risk of coronary heart disease, sudden cardiac death, heart failure, atrial fibrillation, stroke, cardiovascular disease, total cancer and all-cause mortality with greater resting heart rate.
Collapse
Affiliation(s)
- D Aune
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Department of Epidemiology and Public Health, Imperial College, London, UK; Bjørknes University College, Oslo, Norway.
| | - A Sen
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - B ó'Hartaigh
- Department of Radiology, Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, USA; Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, Adler Geriatric Center, New Haven, USA
| | - I Janszky
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - P R Romundstad
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - S Tonstad
- Department of Preventive Cardiology, Oslo University Hospital Ullevål, Oslo, Norway
| | - L J Vatten
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| |
Collapse
|
26
|
Kronenberg G, Schöner J, Nolte C, Heinz A, Endres M, Gertz K. Charting the perfect storm: emerging biological interfaces between stress and stroke. Eur Arch Psychiatry Clin Neurosci 2017; 267:487-494. [PMID: 28393267 PMCID: PMC5561158 DOI: 10.1007/s00406-017-0794-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 03/25/2017] [Indexed: 12/20/2022]
Abstract
A growing body of evidence demonstrates that psychosocial stress is an important and often underestimated risk factor for cardiovascular disease such as myocardial infarction and stroke. In this article, we map out major biological interfaces between stress, stress-related psychiatric disorders, and stroke, placing special emphasis on the fact that stress and psychiatric disorders may be both cause and consequence of cardiovascular disease. Apart from high-risk lifestyle habits such as smoking and lack of exercise, neuroendocrine dysregulation, alterations of the hemostatic system, increased oxidative stress, and inflammatory changes have been implicated in stress-related endothelial dysfunction. Heart rate provides another useful and easily available measure that reflects the complex interplay of vascular morbidity and psychological distress. Importantly, heart rate is emerging as a valuable predictor of stroke outcome and, possibly, even a target for therapeutic intervention. Furthermore, we review recent findings highlighting the role of FK506-binding protein 51 (FKBP5), a co-chaperone of the glucocorticoid receptor, and of perturbations in telomere maintenance, as potential mediators between stress and vascular morbidity. Finally, psychiatric sequelae of cardiovascular events such as post-stroke depression or posttraumatic stress disorder are highly prevalent and may, in turn, exert far-reaching effects on recovery and outcome, quality of life, recurrent ischemic events, medication adherence, and mortality.
Collapse
Affiliation(s)
- G. Kronenberg
- 0000 0000 9737 0454grid.413108.fKlinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsmedizin Rostock, Rostock, Germany ,0000 0001 2218 4662grid.6363.0Klinik und Poliklinik für Psychiatrie und Psychotherapie, Charité Universitätsmedizin Berlin, Charité Campus Mitte, Berlin, Germany ,0000 0001 2218 4662grid.6363.0Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin Berlin, Berlin, Germany
| | - J. Schöner
- 0000 0001 2218 4662grid.6363.0Klinik und Poliklinik für Psychiatrie und Psychotherapie, Charité Universitätsmedizin Berlin, Charité Campus Mitte, Berlin, Germany ,0000 0001 2218 4662grid.6363.0Klinik und Poliklinik für Neurologie, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany ,0000 0001 2218 4662grid.6363.0Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin Berlin, Berlin, Germany
| | - C. Nolte
- 0000 0001 2218 4662grid.6363.0Klinik und Poliklinik für Neurologie, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany ,0000 0001 2218 4662grid.6363.0Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin Berlin, Berlin, Germany
| | - A. Heinz
- 0000 0001 2218 4662grid.6363.0Klinik und Poliklinik für Psychiatrie und Psychotherapie, Charité Universitätsmedizin Berlin, Charité Campus Mitte, Berlin, Germany
| | - M. Endres
- 0000 0001 2218 4662grid.6363.0Klinik und Poliklinik für Neurologie, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany ,0000 0001 2218 4662grid.6363.0Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin Berlin, Berlin, Germany ,0000 0004 0438 0426grid.424247.3German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany ,grid.452396.fGerman Center for Cardiovascular Research (DZHK), Berlin, Germany
| | - Karen Gertz
- Klinik und Poliklinik für Neurologie, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany. .,Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin Berlin, Berlin, Germany.
| |
Collapse
|
27
|
Anker MS, Ebner N, Hildebrandt B, Springer J, Sinn M, Riess H, Anker SD, Landmesser U, Haverkamp W, von Haehling S. Resting heart rate is an independent predictor of death in patients with colorectal, pancreatic, and non-small cell lung cancer: results of a prospective cardiovascular long-term study. Eur J Heart Fail 2016; 18:1524-1534. [DOI: 10.1002/ejhf.670] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 08/28/2016] [Accepted: 09/02/2016] [Indexed: 12/18/2022] Open
Affiliation(s)
- Markus S. Anker
- Charité-Campus Benjamin Franklin (CBF); Department of Cardiology; Berlin Germany
| | - Nicole Ebner
- Innovative Clinical Trials, University Medicine Gottingen (UMG); Department of Cardiology and Pneumology; Gottingen Germany
| | - Bert Hildebrandt
- Charité-Campus Virchow-Klinikum (CVK); Department of Hematology and Oncology; Berlin Germany
| | - Jochen Springer
- Innovative Clinical Trials, University Medicine Gottingen (UMG); Department of Cardiology and Pneumology; Gottingen Germany
| | - Marianne Sinn
- Charité-Campus Virchow-Klinikum (CVK); Department of Hematology and Oncology; Berlin Germany
| | - Hanno Riess
- Charité-Campus Virchow-Klinikum (CVK); Department of Hematology and Oncology; Berlin Germany
| | - Stefan D. Anker
- Innovative Clinical Trials, University Medicine Gottingen (UMG); Department of Cardiology and Pneumology; Gottingen Germany
| | - Ulf Landmesser
- Charité-Campus Benjamin Franklin (CBF); Department of Cardiology; Berlin Germany
| | - Wilhelm Haverkamp
- Charité-Campus Virchow-Klinikum (CVK); Department of Cardiology; Berlin Germany
| | - Stephan von Haehling
- Innovative Clinical Trials, University Medicine Gottingen (UMG); Department of Cardiology and Pneumology; Gottingen Germany
| |
Collapse
|
28
|
Narayanan K, Chugh SS. The 12-lead electrocardiogram and risk of sudden death: current utility and future prospects. Europace 2016; 17 Suppl 2:ii7-13. [PMID: 26842119 DOI: 10.1093/europace/euv121] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
More than 100 years after it was first invented, the 12-lead electrocardiogram (ECG) continues to occupy an important place in the diagnostic armamentarium of the practicing clinician. With the recognition of relatively rare but important clinical entities such as Wolff-Parkinson-White and the long QT syndrome, this clinical tool was firmly established as a test for assessing risk of sudden cardiac death (SCD). However, over the past two decades the role of the ECG in risk prediction for common forms of SCD, for example in patients with coronary artery disease, has been the focus of considerable investigation. Especially in light of the limitations of current risk stratification approaches, there is a renewed focus on this broadly available and relatively inexpensive test. Various abnormalities of depolarization and repolarization on the ECG have been linked to SCD risk; however, more focused work is needed before they can be deployed in the clinical arena. The present review summarizes the current knowledge on various ECG risk markers for prediction of SCD and discusses some future directions in this field.
Collapse
Affiliation(s)
- Kumar Narayanan
- The Heart Institute, Advanced Health Sciences Pavilion Suite A3100, Cedars-Sinai Medical Center, 127 S. San Vicente Blvd, Los Angeles, CA 90048, USA
| | - Sumeet S Chugh
- The Heart Institute, Advanced Health Sciences Pavilion Suite A3100, Cedars-Sinai Medical Center, 127 S. San Vicente Blvd, Los Angeles, CA 90048, USA
| |
Collapse
|
29
|
Zhang D, Wang W, Li F. Association between resting heart rate and coronary artery disease, stroke, sudden death and noncardiovascular diseases: a meta-analysis. CMAJ 2016; 188:E384-E392. [PMID: 27551034 DOI: 10.1503/cmaj.160050] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Resting heart rate is linked to risk of coronary artery disease, stroke, sudden death and noncardiovascular diseases. We conducted a meta-analysis to assess these associations in general populations and in populations of patients with hypertension or diabetes mellitus. METHODS We searched PubMed, Embase and MEDLINE from inception to Mar. 5, 2016. We used a random-effects model to combine study-specific relative risks (RRs). We used restricted cubic splines to assess the dose-response relation. RESULTS We included 45 nonrandomized prospective cohort studies in the meta-analysis. The multivariable adjusted RR with an increment of 10 beats/min in resting heart rate was 1.12 (95% confidence interval [CI] 1.09-1.14) for coronary artery disease, 1.05 (95% CI 1.01-1.08) for stroke, 1.12 (95% CI 1.02-1.24) for sudden death, 1.16 (95% CI 1.12-1.21) for noncardiovascular diseases, 1.09 (95% CI 1.06-1.12) for all types of cancer and 1.25 (95% CI 1.17-1.34) for noncardiovascular diseases excluding cancer. All of these relations were linear. In an analysis by category of resting heart rate (< 60 [reference], 60-70, 70-80 and > 80 beats/min), the RRs were 0.99 (95% CI 0.93-1.04), 1.08 (95% CI 1.01-1.16) and 1.30 (95% CI 1.19-1.43), respectively, for coronary artery disease; 1.08 (95% CI 0.98-1.19), 1.11 (95% CI 0.98-1.25) and 1.08 (95% CI 0.93-1.25), respectively, for stroke; and 1.17 (95% CI 0.94-1.46), 1.31 (95% CI 1.12-1.54) and 1.57 (95% CI 1.39-1.77), respectively, for noncardiovascular diseases. After excluding studies involving patients with hypertension or diabetes, we obtained similar results for coronary artery disease, stroke and noncardiovascular diseases, but found no association with sudden death. INTERPRETATION Resting heart rate was an independent predictor of coronary artery disease, stroke, sudden death and noncardiovascular diseases over all of the studies combined. When the analysis included only studies concerning general populations, resting heart rate was not associated with sudden death.
Collapse
Affiliation(s)
- Dongfeng Zhang
- Department of Epidemiology and Health Statistics, Medical College of Qingdao University, Shandong, Qingdao, China
| | - Weijing Wang
- Department of Epidemiology and Health Statistics, Medical College of Qingdao University, Shandong, Qingdao, China
| | - Fang Li
- Department of Epidemiology and Health Statistics, Medical College of Qingdao University, Shandong, Qingdao, China
| |
Collapse
|
30
|
Resting heart rate as a prognostic factor for mortality in patients with breast cancer. Breast Cancer Res Treat 2016; 159:375-84. [PMID: 27544225 DOI: 10.1007/s10549-016-3938-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 08/04/2016] [Indexed: 10/21/2022]
Abstract
Although elevated resting heart rate (RHR) has been shown to be associated with mortality in the general population and patients with certain diseases, no study has examined this association in patients with breast cancer. A total of 4786 patients with stage I-III breast cancer were retrospectively selected from the Severance hospital breast cancer registry in Seoul, Korea. RHR was measured at baseline and the mean follow-up time for all patients was 5.0 ± 2.5 years. Hazard ratios (HRs) with 95 % confidence intervals (CIs) were calculated using Cox regression models. After adjustment for prognostic factors, patients in the highest quintile of RHR (≥85 beat per minute (bpm)) had a significantly higher risk of all-cause mortality (HR: 1.57; 95 %CI 1.05-2.35), breast cancer-specific mortality (HR: 1.69; 95 %CI 1.07-2.68), and cancer recurrence (HR: 1.49; 95 %CI 0.99-2.25), compared to those in the lowest quintile (≤67 bpm). Moreover, every 10 bpm increase in RHR was associated with 15, 22, and 6 % increased risk of all-cause mortality, breast cancer-specific mortality, and cancer recurrence, respectively. However, the association between RHR and cancer recurrence was not statistically significant (p = 0.26). Elevated RHR was associated with an increased risk of mortality in patients with breast cancer. The findings from this study suggest that RHR may be used as a prognostic factor for patients with breast cancer in clinical settings.
Collapse
|
31
|
The association of resting heart rate and mortality by gender in a rural adult Chinese population: a cohort study with a 6-year follow-up. J Public Health (Oxf) 2016. [DOI: 10.1007/s10389-016-0760-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
|
32
|
Chang SS, Bjørngaard JH, Tsai MK, Bjerkeset O, Wen CP, Yip PSF, Tsao CK, Gunnell D. Heart rate and suicide: findings from two cohorts of 533 000 Taiwanese and 75 000 Norwegian adults. Acta Psychiatr Scand 2016; 133:277-88. [PMID: 26493376 DOI: 10.1111/acps.12513] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/17/2015] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To investigate the association of resting heart rate with suicide in two large cohorts. METHOD The MJ cohort (Taiwan) included 532 932 adults from a health check-up programme (1994-2008). The HUNT cohort (Norway) included 74 977 adults in the Nord-Trøndelag County study (1984-1986), followed up to 2004. In both cohorts heart rate was measured at baseline, and suicide was ascertained through linkage to cause-of-death registers. Risk of suicide was estimated using Cox proportional hazards models. RESULTS There were 569 and 188 suicides (average follow-up period of 8.1 and 16.9 years) in the MJ and HUNT cohorts respectively. Sex- and age-adjusted hazard ratio for every 10 beat increase in heart rate per minute was 1.08 (95% Confidence Interval 1.00-1.16) and 1.24 (1.12-1.38) in the MJ and HUNT cohorts, respectively. In the MJ cohort this association was confined to individuals with a history of heart diseases vs. those without such a history (P for interaction = 0.008). In the HUNT cohort the association did not differ by history of heart diseases and was robust to adjustment for health-related life style, medication use, and symptoms of anxiety and depression. CONCLUSION Elevated resting heart rate may be a marker of increased suicide risk.
Collapse
Affiliation(s)
- S-S Chang
- Institute of Health Behaviors and Community Sciences, and Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan.,Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong SAR, China.,Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China
| | - J H Bjørngaard
- Department of Public Health, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.,Forensic Department and Research Centre, Bröset St. Olav's University Hospital Trondheim, Trondheim, Norway
| | - M K Tsai
- China Medical University Hospital, Taichung, Taiwan.,Institute of Population Health Science, National Health Research Institutes, Miaoli, Taiwan
| | - O Bjerkeset
- Faculty of Health Sciences, Nord-Trøndelag University College (HiNT), Levanger, Norway.,Institute of Neuromedicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - C P Wen
- China Medical University Hospital, Taichung, Taiwan.,Institute of Population Health Science, National Health Research Institutes, Miaoli, Taiwan
| | - P S F Yip
- Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong SAR, China.,Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China
| | - C K Tsao
- MJ Health Management Institution, Taipei, Taiwan
| | - D Gunnell
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| |
Collapse
|
33
|
Zhang D, Shen X, Qi X. Resting heart rate and all-cause and cardiovascular mortality in the general population: a meta-analysis. CMAJ 2015; 188:E53-E63. [PMID: 26598376 DOI: 10.1503/cmaj.150535] [Citation(s) in RCA: 172] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2015] [Indexed: 12/19/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Dongfeng Zhang
- Departments of Epidemiology and Health Statistics (Zhang, Shen), and Clinical Medicine (Qi), Medical College of Qingdao University, Shandong, China
| | - Xiaoli Shen
- Departments of Epidemiology and Health Statistics (Zhang, Shen), and Clinical Medicine (Qi), Medical College of Qingdao University, Shandong, China
| | - Xin Qi
- Departments of Epidemiology and Health Statistics (Zhang, Shen), and Clinical Medicine (Qi), Medical College of Qingdao University, Shandong, China
| |
Collapse
|
34
|
Li Y. Association between resting heart rate and cardiovascular mortality: evidence from a meta-analysis of prospective studies. Int J Clin Exp Med 2015; 8:15329-15339. [PMID: 26629022 PMCID: PMC4658911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 09/06/2015] [Indexed: 06/05/2023]
Abstract
The results from published studies on resting heart rate (RHR) and risk of cardiovascular mortality are not consistent. We therefore conducted a meta-analysis to quantitatively summarize the evidence from prospective studies about the association of RHR with risk cardiovascular mortality. Pertinent studies were identified by a search of Pubmed and Web of Knowledge to January 2015. The random effect model was used. Sensitivity analysis and publication bias were conducted. Dose-response relationship was assessed by restricted cubic spline and variance-weighted least squares regression analysis. Twenty prospective articles were included in this meta-analysis. Pooled results suggested that highest RHR level versus lowest levels was significantly associated with the risk of cardiovascular mortality [summary relative risk (RR) = 1.69, 95% CI = 1.42-2.00, I(2) = 87.5%]. Subjects with RHR levels of > 80 bites per minute (bpm) had a RR of 1.49 (1.24-1.79) for cardiovascular mortality. The results for subgroups analysis of geographic locations, sex and duration of follow-up are consistent with the overall results. The linear dose-response analysis indicated that an increase in RHR of 10 bpm was statistically significantly associated with a 6% increase in the risk of developing cardiovascular mortality (summary RR = 1.06, 95% CI = 1.04-1.08). Thus, we conclude that elevated RHR was significantly associated with an increased risk of cardiovascular mortality.
Collapse
Affiliation(s)
- Yuechun Li
- Department of Cardiology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine Shanghai, China
| |
Collapse
|
35
|
Hart J. Testing an association between baseline resting pulse rate averages and short-term changes in resting pulse rates: A pilot study. THE JOURNAL OF THE CANADIAN CHIROPRACTIC ASSOCIATION 2015; 59:165-172. [PMID: 26136609 PMCID: PMC4486991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Resting heart (pulse) rate (RPR) monitoring may be a useful neurological assessment tool in chiropractic practice. Lower RPR generally reflects a better level of fitness and health status than higher RPR. However, the clinical significance of short-term changes in RPR remains unknown. The purpose of this study was to take an initial step towards understanding the clinical significance of short-term RPR changes, first, by describing short-term RPR changes between duplicated measurements, and second, by comparing RPR changes between groups with lower and higher baseline RPR. METHODS Seventy-three healthy adult volunteers received an RPR measurement on two days within a 1-week period. The mean difference between the two measurements (RPR change) in patients with lower versus higher baseline RPR was compared. RESULTS Mean RPR change in the low baseline group was -0.3 BPM (95% confidence interval [CI] = -2.7 to 2.1 BPM) whereas in the high baseline group, it was +4.4 BPM (95% CI = 1.2 to 7.6). This difference between groups was statistically significant (P = 0.02) Testing an association between baseline resting pulse rate averages and short-term changes in resting pulse rates: A pilot study with a large effect size (Cohen's d = 0.57). CONCLUSION In this pilot study, a higher RPR at baseline was associated with increased RPR change, whereas a lower baseline RPR was associated with a stable or reduced RPR change. A future main study with a larger sample size and longer follow-up period is needed to better characterize both the natural variation of RPR over multiple repeated measurements, and the clinical significance of short-term RPR changes in terms of predicting longer-term health outcomes.
Collapse
|
36
|
Giese-Davis J, Wilhelm FH, Tamagawa R, Palesh O, Neri E, Taylor CB, Kraemer HC, Spiegel D. Higher vagal activity as related to survival in patients with advanced breast cancer: an analysis of autonomic dysregulation. Psychosom Med 2015; 77:346-55. [PMID: 25886831 PMCID: PMC5509754 DOI: 10.1097/psy.0000000000000167] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE High levels of high-frequency heart rate variability (HF-HRV), related to parasympathetic-nervous-system functioning, have been associated with longer survival in patients with myocardial infarction and acute trauma and in patients undergoing palliative care. From animal studies linking higher vagal activity with better immune system functioning and reduced metastases, we hypothesized that higher HF-HRV would predict longer survival in patients with metastatic or recurrent breast cancer (MRBC). METHODS Eighty-seven patients with MRBC participated in a laboratory task including a 5-minute resting baseline electrocardiogram. HF-HRV was computed as the natural logarithm of the summed power spectral density of R-R intervals (0.15-0.50 Hz). In this secondary analysis of a study testing whether diurnal cortisol slope predicted survival, we tested the association between resting baseline HF-HRV on survival using Cox proportional hazards models. RESULTS A total of 50 patients died during a median follow-up of 7.99 years. Higher baseline HF-HRV predicted significantly longer survival, with a hazard ratio of 0.75 (95% confidence interval = 0.60-0.92, p = .006). Visceral metastasis status and baseline heart rate were related to both HF-HRV and survival. However, a combination of HF-HRV and heart rate further improved survival prediction, with a hazard ratio of 0.64 (95% confidence interval = 0.48-0.85, p = .002). CONCLUSIONS Vagal activity of patients with MRBC strongly predicted their survival, extending the known predictive window of HF-HRV in cancer beyond palliative care. Vagal activity can be altered by behavioral, pharmacological, and surgical interventions and may be a promising target for extending life expectancy in patients with metastasizing cancer.
Collapse
Affiliation(s)
- Janine Giese-Davis
- Department of Oncology, Division of Psychosocial Oncology, University of Calgary
- Tom Baker Cancer Centre, Psychosocial Resources, Calgary, Alberta
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine
| | - Frank H. Wilhelm
- Department of Psychology, Division of Clinical Psychology, Psychotherapy, & Health Psychology, University of Salzburg
| | - Rie Tamagawa
- Department of Oncology, Division of Psychosocial Oncology, University of Calgary
- Tom Baker Cancer Centre, Psychosocial Resources, Calgary, Alberta
| | - Oxana Palesh
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine
| | - Eric Neri
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine
| | - C. Barr Taylor
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine
| | - Helena C. Kraemer
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine
| | - David Spiegel
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine
| |
Collapse
|
37
|
Korshøj M, Lidegaard M, Kittel F, Van Herck K, De Backer G, De Bacquer D, Holtermann A, Clays E. The relation of ambulatory heart rate with all-cause mortality among middle-aged men: a prospective cohort study. PLoS One 2015; 10:e0121729. [PMID: 25811891 PMCID: PMC4374890 DOI: 10.1371/journal.pone.0121729] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 02/03/2015] [Indexed: 11/18/2022] Open
Abstract
The aim of this study was to investigate the association between average 24-hour ambulatory heart rate and all-cause mortality, while adjusting for resting clinical heart rate, cardiorespiratory fitness, occupational and leisure time physical activity as well as classical risk factors. A group of 439 middle-aged male workers free of baseline coronary heart disease from the Belgian Physical Fitness Study was included in the analysis. Data were collected by questionnaires and clinical examinations from 1976 to 1978. All-cause mortality was collected from the national mortality registration with a mean follow-up period of 16.5 years, with a total of 48 events. After adjustment for all before mentioned confounders in a Cox proportional hazards regression analysis, a significant increased risk for all-cause mortality was found among the tertile of workers with highest average ambulatory heart rate compared to the tertile with lowest ambulatory heart rate (Hazard ratio = 3.21, 95% confidence interval: 1.22–8.44). No significant independent association was found between resting clinic heart rate and all-cause mortality. The study indicates that average 24-hour ambulatory heart rate is a strong predictor of all-cause mortality independent from resting clinic heart rate, cardiorespiratory fitness, occupational and leisure time physical activity and other classical risk factors among healthy middle-aged workers.
Collapse
Affiliation(s)
- Mette Korshøj
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Mark Lidegaard
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - France Kittel
- School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
| | - Koen Van Herck
- Department of Public Health, Ghent University, Ghent, Belgium
| | - Guy De Backer
- Department of Public Health, Ghent University, Ghent, Belgium
| | - Dirk De Bacquer
- Department of Public Health, Ghent University, Ghent, Belgium
| | - Andreas Holtermann
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Els Clays
- Department of Public Health, Ghent University, Ghent, Belgium
- * E-mail:
| |
Collapse
|
38
|
Floyd JS, Sitlani CM, Wiggins KL, Wallace E, Suchy-Dicey A, Abbasi SA, Carnethon MR, Siscovick DS, Sotoodehnia N, Heckbert SR, McKnight B, Rice KM, Psaty BM. Variation in resting heart rate over 4 years and the risks of myocardial infarction and death among older adults. Heart 2015; 101:132-8. [PMID: 25214500 PMCID: PMC4286483 DOI: 10.1136/heartjnl-2014-306046] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE Resting heart rate (RHR) is an established predictor of myocardial infarction (MI) and mortality, but the relationship between variation in RHR over a period of several years and health outcomes is unclear. We evaluated the relationship between long-term variation in RHR and the risks of incident MI and mortality among older adults. METHODS 1991 subjects without cardiovascular disease from the Cardiovascular Health Study were included. RHR was taken from resting ECGs at the first five annual study visits. RHR mean, trend and variation were estimated with linear regression. Subjects were followed for incident MI and death until December 2010. HRs for RHR mean, trend and variation are reported for differences of 10 bpm, 2 bpm/year and 2 bpm, respectively. RESULTS 262 subjects had an incident MI event (13%) and 1326 died (67%) during 12 years of median follow-up. In primary analyses adjusted for cardiovascular risk factors, RHR mean (HR 1.12; 95% CI 1.05 to 1.20) and variation (HR 1.08; 95% CI 1.03 to 1.13) were associated with the risk of death while trend was not. None of the RHR variables were significantly associated with the risk of incident MI events; however, CIs were wide and the MI associations with RHR variables were not significantly different from the mortality associations. Adjusting for additional variables did not affect estimates, and there were no significant interactions with sex. CONCLUSIONS Variation in RHR over a period of several years represents a potential predictor of long-term mortality among older persons free of cardiovascular disease.
Collapse
Affiliation(s)
- James S Floyd
- Cardiovascular Health Research Unit, University of Washington, Seattle, Washington, USA Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Colleen M Sitlani
- Cardiovascular Health Research Unit, University of Washington, Seattle, Washington, USA Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Kerri L Wiggins
- Cardiovascular Health Research Unit, University of Washington, Seattle, Washington, USA Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Erin Wallace
- Cardiovascular Health Research Unit, University of Washington, Seattle, Washington, USA
| | - Astrid Suchy-Dicey
- Cardiovascular Health Research Unit, University of Washington, Seattle, Washington, USA
| | - Siddique A Abbasi
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - David S Siscovick
- Cardiovascular Health Research Unit, University of Washington, Seattle, Washington, USA Department of Medicine, University of Washington, Seattle, Washington, USA Department of Epidemiology, University of Washington, Seattle, Washington, USA Group Health Research Institute, Group Health Cooperative, Seattle, Washington, USA
| | - Nona Sotoodehnia
- Cardiovascular Health Research Unit, University of Washington, Seattle, Washington, USA Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Susan R Heckbert
- Cardiovascular Health Research Unit, University of Washington, Seattle, Washington, USA Department of Epidemiology, University of Washington, Seattle, Washington, USA Group Health Research Institute, Group Health Cooperative, Seattle, Washington, USA
| | - Barbara McKnight
- Cardiovascular Health Research Unit, University of Washington, Seattle, Washington, USA Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Kenneth M Rice
- Cardiovascular Health Research Unit, University of Washington, Seattle, Washington, USA Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, University of Washington, Seattle, Washington, USA Department of Medicine, University of Washington, Seattle, Washington, USA Department of Epidemiology, University of Washington, Seattle, Washington, USA Group Health Research Institute, Group Health Cooperative, Seattle, Washington, USA
| |
Collapse
|
39
|
van Kruijsdijk RCM, van der Graaf Y, Bemelmans RHH, Nathoe HM, Peeters PHM, Visseren FLJ. The relation between resting heart rate and cancer incidence, cancer mortality and all-cause mortality in patients with manifest vascular disease. Cancer Epidemiol 2014; 38:715-21. [PMID: 25448083 DOI: 10.1016/j.canep.2014.09.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Revised: 09/08/2014] [Accepted: 09/13/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND Previous studies suggest that elevated resting heart rate (RHR) is related to an increased risk of cancer mortality. The aim of this study was to evaluate the relation between RHR and cancer incidence and mortality in patients with vascular disease. METHODS Patients with manifest vascular disease (n=6007) were prospectively followed-up for cancer incidence and mortality. At baseline, RHR was obtained from an electrocardiogram. The relation between RHR and cancer incidence, cancer mortality and total mortality was assessed using competing risks models. RESULTS During a median follow-up of 6.0 years (interquartile range: 3.1-9.3) 491 patients (8%) were diagnosed with cancer and 907 (15%) patients died, 248 (27%) died from cancer. After adjustment for potential confounders, the hazard ratio (HR) for incident cancer per 10 beats/min increase in RHR was 1.00 (95% confidence interval [CI]: 0.93-1.07). There was a trend toward an increased risk of colorectal cancer in patients with higher RHR (HR 1.15, 95% CI 0.97-1.36). The risk of all-cause mortality was increased in patients in the highest quartile of RHR compared to the lowest quartile (HR 1.86, 95% CI 1.53-2.27), but no effect of RHR on cancer mortality was observed (HR 1.01, 95% CI 0.70-1.46). CONCLUSIONS In patients with manifest vascular disease, elevated RHR was related to a higher risk of premature all-cause mortality, but this was not due to increased cancer mortality. RHR was not related to risk of overall cancer incidence, although a relation between elevated RHR and incident colorectal cancer risk could not be ruled out.
Collapse
Affiliation(s)
| | - Yolanda van der Graaf
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Remy H H Bemelmans
- Department of Vascular Medicine, University Medical Centre Utrecht, The Netherlands
| | - Hendrik M Nathoe
- Department of Cardiology, University Medical Centre Utrecht, The Netherlands
| | - Petra H M Peeters
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Centre Utrecht, The Netherlands.
| |
Collapse
|
40
|
A role for cAMP-driven transactivation of EGFR in cancer aggressiveness - therapeutic implications. Med Hypotheses 2014; 83:142-7. [PMID: 24932579 DOI: 10.1016/j.mehy.2014.05.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 04/18/2014] [Accepted: 05/01/2014] [Indexed: 12/29/2022]
Abstract
In many common cancers, production of cAMP boosts cancer proliferation, survival, and aggressiveness, reflecting the fact that, through mechanisms that require further clarification, cAMP can promote tyrosine phosphorylation, notably transactivation of the epidermal growth factor receptor (EGFR). Hormones which activate adenylate cyclase in many cancers include PGE2 - often produced by cox-2 activity within tumors - and adrenergic hormones, acting on beta2 receptors. NSAID cyclooxygenase inhibitors, including low-dose aspirin, clearly reduce risk for many adenocarcinomas, but the impact of cox-2 inhibitors in clinical cancer therapy remains somewhat equivocal. There is increasing evidence that increased sympathetic drive, often reflecting psychic stress or tobacco usage, increases risk for, and promotes the aggressiveness of, many cancers. The non-specific beta antagonist propranolol shows cancer-retardant activity in pre-clinical rodent studies, especially in stressed animals, and a limited amount of epidemiology concludes that concurrent propranolol usage is associated with superior prognosis in breast cancer, ovarian cancer, and melanoma. Epidemiology correlating increased resting heart rate with increased total cancer mortality can be interpreted as compelling evidence that increased sympathetic drive encourages the onset and progression of common cancers. Conversely, hormones which inhibit adenylate cyclase activity in cancers may have potential for cancer control; GABA, which can be administered as a well-tolerated nutraceutical, has potential in this regard. Combination regimens intended to down-regulate cancer cAMP levels, perhaps used in conjunction with EGFR inhibitors, may have considerable potential for suppressing the contribution of cAMP/EGFR to cancer aggressiveness. This model also predicts that certain other hormones which activate adenylate cylase in various tissue may play a yet-unsuspected role in cancer induction and spread.
Collapse
|
41
|
Duarte CV, Myers J, de Araújo CGS. Exercise heart rate gradient: A novel index to predict all-cause mortality. Eur J Prev Cardiol 2014; 22:629-35. [DOI: 10.1177/2047487314520784] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 12/31/2013] [Indexed: 11/16/2022]
|
42
|
Carlson N, Dixen U, Marott JL, Jensen MT, Jensen GB. Predictive value of casual ECG-based resting heart rate compared with resting heart rate obtained from Holter recording. Scandinavian Journal of Clinical and Laboratory Investigation 2013; 74:163-9. [DOI: 10.3109/00365513.2013.867531] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
|