Relationship between resting heart rate and long-term outcomes in stabilized patients with myocardial infarction: A prospective community-based cohort study

BACKGROUND

Resting heart rate (RHR) during hospitalization has been shown to be associated with adverse outcomes in patients with myocardial infarction (MI). This study aimed to evaluate the long-term prognostic effect of RHR during the stable phase after MI in post-MI patients.

METHODS

Patients who had prior or new-onset MI and RHR measurements during the stable period after MI between 2006 and 2018 in the community-based Kailuan Study were enrolled. RHR was divided into four groups based on quartiles. Cox regression analysis was used to analyze the association of RHR with primary composite outcome of all-cause death, hospitalization for heart failure (HF), stroke, and recurrent MI and its components.

RESULTS

A total of 4447 post-MI patients were included. During a median follow-up of 7.5 years, 1813 patients (40.8%) developed primary outcomes. Compared to RHR ≤67 bpm, patients with 72 < RHR ≤80 bpm and RHR >80 bpm had increased risks of primary outcome, with adjusted hazard ratios (95% confidence intervals) of 1.23 (1.08-1.40) and 1.35 (1.18-1.55), respectively. The risk of primary outcome increased by 12% (1.07-1.17) for each 10-bpm increase in RHR. Similar results were observed in all-cause death and hospitalization for HF. Restricted cubic splines revealed a linear relationship between RHR and primary outcome, all-cause death, and hospitalization for HF (P for nonlinearity >0.05).

CONCLUSIONS

RHR during the stable phase after MI was an independent predictor for primary outcome and all-cause death in post-MI patients, and RHR >72 bpm was associated with increased risk for primary outcome and all-cause death.

Resting heart rate and risk of dementia: a Mendelian randomization study in the international genomics of Alzheimer's Project and UK Biobank

Background

Observational studies have demonstrated that a higher resting heart rate (RHR) is associated with an increased risk of dementia. However, it is not clear whether the association is causal. This study aimed to determine the causal effects of higher genetically predicted RHR on the risk of dementia.

Methods

We performed a two-sample Mendelian randomization analysis to investigate the causal effect of higher genetically predicted RHR on Alzheimer's disease (AD) using summary statistics from genome-wide association studies. The generalized summary Mendelian randomization (GSMR) analysis was used to analyze the corresponding effects of RHR on following different outcomes: 1) diagnosis of AD (International Genomics of Alzheimer's Project), 2) family history (maternal and paternal) of AD from UK Biobank, 3) combined meta-analysis including these three GWAS results. Further analyses were conducted to determine the possibility of reverse causal association by adjusting for RHR modifying medication.

Results

The results of GSMR showed no significant causal effect of higher genetically predicted RHR on the risk of AD (βGSMR = 0.12, P = 0.30). GSMR applied to the maternal family history of AD (βGSMR = -0.18, P = 0.13) and to the paternal family history of AD (βGSMR = -0.14, P = 0.39) showed the same results. Furthermore, the results were robust after adjusting for RHR modifying drugs (βGSMR = -0.03, P = 0.72).

Conclusion

Our study did not find any evidence that supports a causal effect of RHR on dementia. Previous observational associations between RHR and dementia are likely attributed to the correlation between RHR and other cardiovascular diseases.

Resting heart rate is associated with the prevalence of chronic kidney disease in Korean adult: the Korean National Health and Nutrition Survey

BACKGROUND

Chronic kidney disease (CKD) poses a significant health challenge, yet early detection remains difficult. Resting heart rate (RHR) has been shown to be a reliable indicator of type 2 diabetes, prompting interest in its potential as an independent predictor of CKD. This study aimed to investigate the association between RHR and CKD prevalence, as well as explore potential interactions between RHR and other risk factors for CKD in a sample of 25,246 adults.

METHODS

Data from the Korean National Health and Nutrition Examination Survey (2011-2014) were utilized for this study, with 19,210 participants included after screening. Logistic regression analysis was employed to examine the relationship between RHR and CKD prevalence. Stratified analyses were conducted based on known risk factors for CKD.

RESULTS

Participants with an RHR ≥ 90 bpm exhibited a 2.07-fold [95% confidence interval (CI): 1.28-3.34] and 2.22-fold (95% CI: 1.42-3.48) higher prevalence of CKD in men and women, respectively, compared to those with an RHR < 60 bpm. The association between RHR and CKD prevalence was particularly pronounced in younger participants (40-59 years vs. ≥ 60 years), individuals with diabetes (yes vs. no), and those with a longer duration of diabetes (≥ 7 years vs. < 7 years).

CONCLUSION

Elevated RHR was found to be significantly associated with a higher prevalence of CKD in both men and women, independent of demographic, lifestyle, and medical factors. These findings suggest that RHR could serve as a valuable predictor for undiagnosed CKD.

Interplay of heart rate variability and resting heart rate on mortality in type 2 diabetes

AIMS

Heart rate variability (HRV) and resting heart rate (RHR) are usually analyzed and interpreted separately. We aimed to assess the interplay of HRV and RHR on mortality in type 2 diabetes.

METHODS

The study included 7,529 participants from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. HRV metrics included standard deviation of all normal-to-normal intervals (SDNN) and root mean square of successive differences between normal-to-normal intervals (rMSSD). Abnormal values were defined based on <25th percentile for HRV and >75th percentile for RHR. Interactions of HRV status and RHR status were tested on multiplicative and additive scales. Results were validated in a subset of patients with type 2 diabetes (n = 745) from the Multi-Ethnic Study of Atherosclerosis.

RESULTS

Low SDNN was associated with increased all-cause mortality in the high RHR group (HR 1.60; 95% CI 1.29-1.97), but not in the normal RHR group. Compared with those who had neither low SDNN nor high RHR, the presence of either low SDNN or high RHR was not significantly associated with an increased risk of all-cause mortality. In contrast, the combination of low SDNN and high RHR was associated with a significantly increased risk of all-cause mortality (HR 1.68; 95% CI 1.43-1.97). Significant multiplicative and additive interactions were found between HRV status and RHR status on risk of all-cause mortality (all Pinteraction < 0.05). Similar findings were observed for cardiovascular mortality, in analyses using rMSSD, and in the Multi-Ethnic Study of Atherosclerosis.

CONCLUSIONS

The association between HRV and mortality risk is modified by RHR levels. Furthermore, low HRV and high RHR have interdependent and synergistic associations with mortality risk.

Resting heart rate, cognitive function, and inflammation in older adults: a population-based study

BACKGROUND

Emerging evidence has linked elevated resting heart rate (RHR) with poor cognitive function in older adults, but the mechanisms underlying their association are poorly understood.

METHODS

This population-based cross-sectional study included 4510 dementia-free participants (age ≥ 65 years; 56.9% females; 38.3% no formal education) in the baseline examination of the Multidomain Interventions to Delay Dementia and Disability in Rural China study. Of these, 1,386 had data on serum proinflammatory cytokines and adhesion molecules. RHR was measured using 12-lead electrocardiograph. We used the Mini-Mental State Examination (MMSE) and a neuropsychological test battery to assess cognitive function. Data were analyzed using the general linear and restricted cubic splines models.

RESULTS

People with high RHR were more likely to have cardiometabolic diseases and worse cognitive function (p < 0.05). There was an inverted J-shaped association of RHR with MMSE and attention scores. Having RHR ≥ 80 bpm (vs. 60-69 bpm) was significantly associated with the multivariable-adjusted β coefficients of - 0.58 [95% confidence interval (CI), - 1.00, - 0.16] for MMSE score and - 0.08 (- 0.15, - 0.01) for attention score. In the serum biomarker subsample, RHR was linearly associated with serum interleukin-6 (IL-6) (β coefficient = 0.19; 95%CI 0.14, 0.24), IL-8 (0.08; 0.02, 0.13), IL-10 (0.09; 0.04, 0.15), tumor necrosis factor-α (0.06; 0.01, 0.11), monocyte chemotactic protein-1 (0.09; 0.04, 0.15), intercellular adhesion molecule-1 (0.16; 0.11, 0.22), and vascular cell adhesion molecule-1 (0.11; 0.06, 0.16).

CONCLUSIONS

There is an inverted J-shaped association of RHR with attention and global cognition. Poor cognitive function and high RHR may be linked through systemic low-grade inflammation and endothelial injury.

Associations between baseline heart rate and blood pressure and time to events in heart failure with reduced ejection fraction patients: Data from the QUALIFY international registry

AIMS

A high resting heart rate (RHR) and low systolic blood pressure (SBP) are a risk factor and a risk indicator, respectively, for poor heart failure (HF) outcomes. This analysis evaluated the associations between baseline RHR and SBP with outcomes and treatment patterns in patients with HF and reduced ejection fraction (HFrEF) in the QUALIFY (QUality of Adherence to guideline recommendations for LIFe-saving treatment in heart failure surveY) international registry.

METHODS AND RESULTS

Between September 2013 and December 2014, 7317 HFrEF patients with a previous HF hospitalization within 1-15 months were enrolled in the QUALIFY registry. Complete follow-up data were available for 5138 patients. The relationships between RHR and SBP and outcomes were assessed using a Cox proportional hazards model and were analysed according to baseline values as high RHR (H-RHR) ≥75 bpm versus low RHR (L-RHR) <75 bpm and high SBP (H-SBP) ≥110 mmHg versus low SBP (L-SBP) <110 mmHg and analysed according to each of the following four phenotypes: H-RHR/L-SBP, L-RHR/L-SBP, H-RHR/H-SBP and L-RHR/H-SBP (reference group). Compared to the reference group, H-RHR/L-SBP was associated with the worst outcomes for the combined primary endpoint of cardiovascular death and HF hospitalization (hazard ratio [HR] 1.83, 95% confidence interval [CI] 1.51-2.21, p < 0.001), cardiovascular death (HR 2.70, 95% CI 1.69-4.33, p < 0.001), and HF hospitalization (HR 1.62, 95% CI 1.30-2.01, p < 0.001). Low-risk patients with L-RHR/H-SBP achieved more frequently ≥50% of target doses of angiotensin-converting enzyme inhibitors (ACEIs) and beta-blockers (BBs) than the other groups. However, 48% and 46% of low-risk patients were not well treated with ACEIs and BBs, respectively (≤50% of target dose or no treatment).

CONCLUSION

In patients with HFrEF and recent hospitalization, elevated RHR and lower SBP identify patients at increased risk for cardiovascular endpoints. While SBP and RHR are often recognized as barriers that deter physicians from treating with high doses of recommended drugs, they are not the only reason leaving many patients suboptimally treated.

Insight into the relationship between resting heart rate and atrial fibrillation: a Mendelian randomization study

AIMS

A low resting heart rate (RHR) implies a more efficient heart function and a lower risk of cardiovascular disease. However, observational studies have reported a U-shaped association between RHR and atrial fibrillation (AF). In contrast, Mendelian randomization (MR) studies have found an inverse causal association between RHR and AF. Hence, the causal nature of the relationship is not clear. The aim is to investigate the causal association and its shape between RHR on AF using linear and non-linear MR (NLMR).

METHODS AND RESULTS

Linear and non-linear MR were performed on individual-level data in the Trøndelag Health Study (HUNT) and UK Biobank (UKB). HUNT consists of 69 155 individuals with 7,062 AF cases, while UKB provides data on 431 852 individuals with 20 452 AF cases. The linear MR found an inverse relationship between RHR and AF with an OR = 0.95 [95% confidence interval (CI): 0.93-0.98] and OR = 0.96 (95% CI: 0.95-0.97) per unit decrease in RHR in HUNT and UKB, respectively. The NLMR was supportive of an inverse linear relationship in both HUNT and UKB for RHR values <90 beats per minute (bpm). Several sensitivity analyses were also consistent.

CONCLUSION

In contrast with the current observational knowledge of RHR and AF, an inverse causal association between RHR and AF was demonstrated in both linear and non-linear MR for RHR values up to 90 bpm. Further exploring the underlying mechanisms of the genetic instrument for RHR may shed light on whether pleiotropy is biasing this association.

Autonomic dysfunction is associated with the development of arterial stiffness: the Whitehall II cohort

This study aims to examine the association between baseline level and change of autonomic nervous function with subsequent development of arterial stiffness. Autonomic nervous function was assessed in 4901 participants of the Whitehall II occupational cohort by heart rate variability (HRV) indices and resting heart rate (rHR) three times between 1997 and 2009, while arterial stiffness was assessed by carotid-femoral pulse wave velocity (PWV) measured twice between 2007 and 2013. First, individual HRV/rHR levels and annual changes were estimated. Then, we modelled the development of PWV by HRV/rHR using linear mixed effect models. First, we adjusted for sex and ethnicity (model 1), and then for socioeconomic and lifestyle factors, various clinical measurements, and medications (model 2). A decrease in HRV and unchanged rHR was associated with subsequent higher levels of PWV, but the effect of a change in HRV was less pronounced at higher ages. A typical individual aged 65 years with a SDNN level of 30 ms and a 2% annual decrease in SDNN had 1.32 (0.95; 1.69) higher PWV compared to one with the same age and SDNN level but with a 1% annual decrease in SDNN. Further adjustment had no major effect on the results. People who experience a steeper decline in autonomic nervous function have higher levels of arterial stiffness. The association was stronger in younger people.

Move for Your Heart, Break a Sweat for Your Mind: Providing Precision in Adolescent Health and Physical Activity Behaviour Pattern

PURPOSE

Adolescent health benefits of different physical activity (PA) intensities, especially of lower intensities, are debated due to challenges in accelerometer data processing and analyses. Using a new accelerometer data processing method and multivariate pattern analysis, this study investigated the association of PA intensities with indicators of cardiovascular and mental health.

METHODS

Adolescents (n = 1,235, mean age 13.6 years, 41% males) were examined for cardiovascular health: body mass index (BMI) z-score, waist circumference (WC), resting heart rate and blood pressure, white blood cell count (WBC), pulse wave velocity (PWV), and answered questionnaires assessing stress and psychosomatic symptoms. Sex, age, and socioeconomic status were confounders. Hip-worn accelerometer data were processed with 10 Hz frequency extended method and a spectrum of 22 PA intensity categories was analyzed for association with health using partial least squares regression.

RESULTS

Total explained variances for BMI z-score, WC, resting heart rate, stress, and psychosomatic symptoms were higher (3.3%-8.7%) compared to diastolic blood pressure, WBC, and PWV (0.9%-1.4%). We found positive associations of high-end moderate PA and vigorous PA with cardiovascular and mental health indicators. More sedentary time and lower level of light PA were associated with higher BMI z-score, WC, resting heart rate, diastolic blood pressure, WBC, and PWV, but not with mental health indicators. Very vigorous PA was negatively associated with resting heart rate, stress, and psychosomatic symptoms.

DISCUSSION

In adolescents, PA of varying intensities were generally found to be positively associated with better cardiovascular health, but only higher intensity PA was associated with better mental health.

PCovNet+: A CNN-VAE anomaly detection framework with LSTM embeddings for smartwatch-based COVID-19 detection

The world is slowly recovering from the Coronavirus disease 2019 (COVID-19) pandemic; however, humanity has experienced one of its According to work by Mishra et al. (2020), the study's first phase included a cohort of 5,262 subjects, with 3,325 Fitbit users constituting the majority. However, among this large cohort of 5,262 subjects, most significant trials in modern times only to learn about its lack of preparedness in the face of a highly contagious pathogen. To better prepare the world for any new mutation of the same pathogen or the newer ones, technological development in the healthcare system is a must. Hence, in this work, PCovNet+, a deep learning framework, was proposed for smartwatches and fitness trackers to monitor the user's Resting Heart Rate (RHR) for the infection-induced anomaly. A convolutional neural network (CNN)-based variational autoencoder (VAE) architecture was used as the primary model along with a long short-term memory (LSTM) network to create latent space embeddings for the VAE. Moreover, the framework employed pre-training using normal data from healthy subjects to circumvent the data shortage problem in the personalized models. This framework was validated on a dataset of 68 COVID-19-infected subjects, resulting in anomalous RHR detection with precision, recall, F-beta, and F-1 score of 0.993, 0.534, 0.9849, and 0.6932, respectively, which is a significant improvement compared to the literature. Furthermore, the PCovNet+ framework successfully detected COVID-19 infection for 74% of the subjects (47% presymptomatic and 27% post-symptomatic detection). The results prove the usability of such a system as a secondary diagnostic tool enabling continuous health monitoring and contact tracing.

Consistency evaluation of exercise target heart rate determined by resting heart rate and anaerobic threshold in chronic heart failure patients

PURPOSE

To evaluate the consistency on the target heart rate for exercise determined by simple target heart rate (sTHR) based on resting heart rate (HRrest) and heart rate at anaerobic threshold (HRAT) in cardiopulmonary exercise test (CPET) for patients with chronic heart failure.

METHODS

This is a retrospective cohort study, in which CHF patients who underwent CPET in Tongji Hospital Cardiac Rehabilitation Center Affiliated to Tongji University from March 2007 to December 2018 were enrolled. The clinical data of the patients from the electronic medical record system, HRrest and HRAT measured by CPET were collected. Patients were further divided into subgroups according to gender, age (<60 years group and ≥ 60 years group), with or without beta-blocker therapy and subgroup of heart failure (heart failure with reduced, mid-range and preserved ejection fraction). The sTHR (HRrest plus 10, 15, 20, 25 and 30 bpm) and HRAT were all calculated in each patient. Paired t-test was used for the difference between the two methods, correlation analysis was shown by pearson analysis and intraclass correlation coefficient (ICC) was calculated for consistency test.

RESULTS

A total of 547 CHF patients were enrolled, including 447 males (81.7%), aged 63 (56,69) years, with BMI of 25.2 (23.5,26.4) kg/m² and LVEF of 45.0 (36.0, 52.0) %. The target heart rate determined by HRAT method was (93.59 ± 13.95) bpm, and its counterpart determined by HRrest plus 20 bpm (HRrest₊₂₀) was (93.16 ± 7.69) bpm. There was no significant difference between the two methods (P>0.05). However, it was statistically different between HRrest plus 10, 15, 25, 30 bpm and HRAT respectively (P<0.001). And HRrest₊₂₀ was positively correlated with HRAT (r = 0.418, P<0.001). Therefore, HRrest₊₂₀ below was regarded as sTHR. The ICC of the consistency test between sTHR and HRAT was 0.523,95%CI 0.435-0.596 (P < 0.001) in all patients (n = 547). In patients with beta-blocker therapy (n = 464), the ICC of sTHR and HRAT consistency test was 0.534,95%CI 0.441-0.612, P < 0.001; The ICC of the consistency test between sTHR and HRAT of patients without beta-blocker therapy (n = 83) was 0.407,95%CI 0.083-0.616, P < 0.05. In the sinus rhythm group (n = 466), the ICC of sTHR and HRAT consistency test was 0.527,95%CI 0.433-0.606, P < 0.001; The ICC of the consistency test between sTHR and HRAT of atrial fibrillation patients in group (n = 81) was 0.482,95%CI 0.195-0.667, P < 0.05.The ICC of the consistency test between sTHR and HRAT was 0.501,95%CI 0.338-0.623 (P < 0.001) in patients under 60 years old (n = 195); The ICC of the consistency test between sTHR and HRAT in patients ≥60 years old (n = 352) was 0.533,95%CI 0.424-0.621, P < 0.001. In the male group (n = 447), the ICC of sTHR and HRAT consistency test was 0.577,95%CI 0.491-0.649, P < 0.001; The ICC of the consistency test between sTHR and HRAT of female patients in group (n = 100) was 0.344,95%CI 0.025-0.559, P < 0.05. The ICC of sTHR and HRAT consistency test in HFrEF group (n = 170) was 0.395,95%CI 0.181-0.553, P < 0.01; The ICC values of the consistency test between sTHR and HRAT was 0.543, 95%CI 0.405-0.649 (P < 0.001) in patients with HFmrEF (n = 222); In HFpEF group (n = 155), the ICC of sTHR and HRAT consistency test was 0.620,95%CI 0.478-0.723, P < 0.001.

CONCLUSION

The exercise target heart rate calculated by HRrest is consistent with that determined by HRAT in patients with CHF. For primary hospitals without CPET, exercise prescription equivalent to AT intensity for patients with CHF can be determined by HRrest. However, the target heart rate calculated by HRrest can't replace that determined by HRAT in this patient cohort completely.

The Immigrant Experience and Alcohol Use: Heart Rate as a Source of Risk and Resilience

The immigration experience in the USA has been linked to a wide range of behavioral and physical outcomes. Studies report that immigrants, relative to native-born citizens, are less likely to develop alcohol use habits despite facing hardship during the acculturation process. Limited research, however, has examined whether and to what extent resting heart rate (RHR) plays a role in accounting for individual differences in the acculturation process in the USA. To begin to address this gap in research, cross-sectional self-report data (N = 4775) from a nationally representative sample of US adults are analyzed to examine the association between the immigrant experience, alcohol use, and drunkenness. The role of low, mean, and high RHR on this association is investigated. The results reveal that respondents with higher levels of the immigrant experience report lower levels of alcohol use and drunkenness. RHR partially conditions the relationship between the immigrant experience and alcohol use, whereby respondents with higher levels of the immigrant experience and high RHR report less alcohol use and drunkenness, compared to more native respondents with low RHR. Immigrant experience and alcohol use were associated, but not with drunkenness among respondents with average RHR levels, relative to those with low RHR levels. The results suggest that RHR may be a potential source of both risk for and resilience to the development of alcohol use behaviors among immigrants going through the acculturation process in the USA.

A NOREPOS cohort study of 367,386 men and women

Enhanced knowledge regarding modifiable risk factors for hip fractures are warranted. We aimed to study the associations between two indicators of physical fitness (resting heart rate and level of physical activity) in middle-aged individuals, and the risk of hip fractures during the subsequent three decades. Data on objectively measured resting heart rate and self-reported leisure time physical activity from a national health survey (1985-1999) was linked to a database including all hip fractures treated in Norwegian hospitals from 1994 through 2018. We calculated hazard ratios (HR) with 95 % confidence intervals (95 % CI) for hip fractures according to categories of resting heart rate (mean of two repeated measures), and leisure time physical activity level in adjusted Cox proportional hazard models. In total, 367,386 persons (52 % women) aged 40 to 45 years were included, of whom 5482 persons sustained a hip fracture during a mean follow-up of 24.8 years. Higher resting heart rate was associated with higher hip fracture risk. Men with a resting heart rate above 80 bpm, who also reported low levels of physical activity, had a HR of 1.82 (95 % CI 1.49-2.22) for hip fracture compared to men with a resting heart rate below 70 bpm who reported high levels of physical activity. The same measure of association for women was 1.62 (95 % CI 1.28-2.06). Physical fitness measured by low resting heart rate in middle age, and a high physical activity level were associated with a lower long-term risk of hip fractures in both men and women.

Prognostic value of resting heart rate in predicting undiagnosed diabetes in adults: Korean National Health and Nutrition Examination Survey 2008-2018

BACKGROUND AND AIM

Although resting heart rate (RHR) is associated with prevalence and incidence of diabetes, whether it is associated with undiagnosed diabetes is still unclear. We aimed to investigate whether the RHR is associated with the prevalence of undiagnosed diabetes in a large Korean national dataset.

METHODS AND RESULTS

The Korean National Health and Nutrition Examination Survey data from 2008 to 2018 were used. After screening, 51,637 participants were included in this study. The odds ratios and 95% confidence intervals (CIs) for undiagnosed diabetes were calculated using multivariable-adjusted logistic regression analyses. Analyses showed that participants with a RHR of ≥90 bpm showed a 4.00- (95% CI: 2.77-5.77) and 3.21-times (95% CI: 2.01-5.14) higher prevalence of undiagnosed diabetes for men and women, respectively, than those with a RHR of <60 bpm. The linear dose-response analyses showed that each 10-bpm increment in RHR was associated with a 1.39- (95% CI: 1.32-1.48) and 1.28-times (95% CI: 1.19-1.37) higher prevalence of undiagnosed diabetes for men and women, respectively. In the stratified analyses, the positive association between RHR and the prevalence of undiagnosed diabetes was tended to be stronger among those who were younger (age: <40 years) and lean (BMI: <23 kg/m²).

CONCLUSIONS

Elevated RHR was significantly associated with a higher prevalence of undiagnosed diabetes in Korean men and women, independent of demographic, lifestyle, and medical factors. Accordingly, the value of RHR as a clinical indicator and health marker, especially in reducing the prevalence of undiagnosed diabetes, is suggestible.

Role of insulin resistance in the association between resting heart rate and type 2 diabetes: A prospective study

BACKGROUND

Elevated resting heart rate (RHR) is a predictor of incident type 2 diabetes (T2D). Insulin resistance is thought to play a role in this association; however, the extent to which insulin resistance mediates this association is unclear.

METHODS

1309 Japanese individuals without diabetes were recruited during 2009-2012 and followed for 5 years, of whom 78 developed T2D, as diagnosed by the 75 g oral glucose tolerance test. Supine RHR was measured by electrocardiography. Using logistic regression analysis, we examined the association between RHR and incident T2D, and interaction with the homeostasis model assessment of insulin resistance (HOMA-IR) index. Causal mediation analysis was applied to decompose the effect of RHR on the outcome and estimate the proportion mediated by the HOMA-IR index.

RESULTS

The sex- and age-adjusted cumulative incidence rate of T2D increased with increasing RHR. After adjustment for sex, age, waist circumference, current smoking status, alcohol use, habitual exercise, and cardiovascular disease medications, individuals with a RHR ≥80 bpm, compared with <60 bpm, showed an increased risk of incident T2D [odds ratio (OR), 2.89; 95 % confidence interval (CI), 1.07 to 7.80]. Multivariate adjusted OR for the total effect per 1 SD increase in RHR on incident T2D was 1.37 (95 % CI, 1.01 to 1.74) in the mediation analysis, and the proportion of the total indirect effect mediated by the HOMA-IR index was 27.5 % (95 % CI, 1.5 to 53.5).

CONCLUSIONS

Approximately 30 % of the effect of RHR on incident T2D was explained by the indirect effect of insulin resistance.

Higher pre-treatment skin sympathetic nerve activity and elevated resting heart rate after chemoradiotherapy predict worse esophageal cancer outcomes

Background

Chemoradiotherapy (CRT), which might affect the autonomic system, is the mainstay therapy for advanced esophageal squamous cell carcinoma (ESCC). Autonomic dysfunction has been found to possibly lead to cancer mortality in those with elevated resting heart rates (RHR). Skin sympathetic nerve activity (SKNA) is a new method of stimulating electrical signals in skin to evaluate autonomic function from sympathetic tone. In this study, we investigated the association between changes in RHR and autonomic function and ESCC mortality.

Methods

Thirty-nine stage II-IV ESCC patients receiving CRT between March 2019 and November 2020 were prospectively enrolled and carefully selected, followed up and received the same meticulous supportive care. Serial RHR was recorded every two weeks from before CRT to eight weeks after CRT and average SKNA were recorded before and four weeks after CRT. All-cause mortality was defined as primary outcome.

Results

We found the RHR of ESCC patients to be significantly elevated and peaking at four weeks after CRT (p < 0.001) and then to gradually decrease. Those with an elevated RHR above the cutoff level (18 beat-per-minute) at eight weeks after CRT had worse overall survival. In addition, those with higher baseline sympathetic tone (average SKNA ≥ 0.86 μV) also had poor outcome.

Conclusions

Increased pre-treatment sympathetic tone and elevated RHR after CRT are alarm signs of poor ESCC outcome. Further exploration of the mechanisms underlying these associations could potentially lead to intervention strategies for reducing mortality.

Trial registration

This study is registered with ClinicalTrials.gov, identifier: NCT03243448.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12885-022-10180-8.

Associations of resting heart rate with incident dementia, cognition, and brain structure: a prospective cohort study of UK biobank

BACKGROUND

Resting heart rate (RHR) has been linked with an increased risk of dementia. However, evidence characterizing the associations of RHR with different dementia subtypes and their underlying mechanisms remains scarce. This study aims to investigate the relationships of RHR with different dementia types, cognitive function, and brain structural abnormalities.

METHODS

Three hundred thirty-nine thousand nine hundred one participants with no prior diagnosis of dementia from the UK biobank were analyzed. Cox regression and restricted cubic spline models examined the associations between RHR with all-cause dementia (ACD) and its major subtypes-Alzheimer's disease (AD) and vascular dementia (VaD). Logistic regression models assessed the associations of RHR with cognitive function, and linear regression models estimated the associations with hippocampal subfield volume and white matter tract integrity indexed by magnetic resonance imaging data.

RESULTS

During an average of 3148 (± 941.08) days of follow-up, 4177 individuals were diagnosed with dementia, including 2354 AD and 989 VaD cases. RHR ≥ 80bpm was associated with ACD (HR: 1.18, 95% CI: 1.08-1.28, P < 0.001) and VaD (HR: 1.29, 95% CI: 1.08-1.54, P = 0.005) but not AD in multi-adjusted models. A 10-bpm increment of RHR demonstrated non-linear effects in VaD, consisting of J-shape relationships. Several heterogeneities were indicated in stratified analysis, in which RHR measures only showed associations with dementia incidents in relatively younger populations (age ≤ 65) and females. Apart from dementia analysis, elevated RHR was associated with worsening performance in fluid intelligence and reaction time of cognitive tasks, decreased hippocampal subfields volume, and poor white matter tract integrity.

CONCLUSIONS

RHR is associated with increased risks of ACD and VaD but also presented with few heterogeneities across different sex and age groups. Elevated RHR also appears to have deleterious effects on cognitive function and is distinctively associated with volume reduction in hippocampal subfields and impaired white matter tract integrity.

Heart failure outcomes according to heart rate and effects of empagliflozin in patients of the EMPEROR-Preserved trial

AIMS

Empagliflozin reduces cardiovascular death (CVD) or heart failure hospitalization (HHF) in patients with heart failure and preserved ejection fraction (HFpEF). Treatment effects and safety in relation to resting heart rate (RHR) have not been studied.

METHODS AND RESULTS

The interplay of RHR and empagliflozin effects in EMPEROR-Preserved was evaluated. We grouped patients (n = 5988) according to their baseline RHR (<70 bpm [n = 2650], 70-75 bpm [n = 967], >75 bpm [n = 1736]) and explored the influence of RHR on CVD or HHF (primary outcome) and its components in sinus rhythm or atrial fibrillation/flutter (AF) and adverse events. We studied the efficacy of empagliflozin across the RHR spectrum. Compared to placebo, empagliflozin did not change heart rate over time. The primary outcome (p for trend = 0.0004) and its components CVD (p trend = 0.0002), first HHF (p for trend = 0.0099) and all-cause death (p <  0.0001) increased with RHR only in sinus rhythm but not AF. The risk increase with RHR was similar in patients with heart failure and mildly reduced ejection fraction (left ventricular ejection fraction [LVEF] 40-49%) and HFpEF (LVEF ≥50%). Baseline RHR had no influence on the effect of empagliflozin on the primary outcomes (p for trend = 0.20), first HHF (p for trend = 0.49). There were no clinically relevant differences in adverse events between empagliflozin and placebo across the RHR groups.

CONCLUSION

Resting heart rate associates with outcomes only in sinus rhythm but not in AF. Empagliflozin reduced outcomes over the entire RHR spectrum without increase of adverse events.

Relationship of resting heart rate and blood pressure with all-cause and cardiovascular disease mortality

OBJECTIVES

This study aimed to investigate associations of resting heart rate (RHR) and blood pressure (BP) with all-cause and cardiovascular disease (CVD) mortality.

STUDY DESIGN

A retrospective cohort study.

METHODS

A total of 67,028 Chinese participants aged ≥60 years were included in the analysis. RHR, systolic blood pressure (SBP), and diastolic blood pressure (DBP) were evaluated according to quartiles ([41-69, 70-74, 75-79, 80-127 beats/min], [80-119, 120-129, 130-139, 140-238 mm Hg], and [40-70, 71-79, 80-84, 85-133 mm Hg]). Cox proportional hazard models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) of all-cause and CVD mortality with RHR, SBP, and DBP. Restricted cubic splines were used to evaluate the dose-response association.

RESULTS

During the 361,975 person-year follow-up, 9326 deaths were recorded, of which 5039 deaths were due to CVD. The risk of all-cause mortality was increased by 25% with the quartiles four vs quartile one of RHR (HR [95% CI]:1.25 [1.17-1.33]), and CVD mortality was increased by 32% (HR [95% CI]: 1.32 [1.22-1.44]). Similar results were observed when comparing the quartiles four vs quartile one of SBP with the risk of all-cause and CVD mortality (HRs [95% CIs]: 1.14 [1.07, 1.22] and 1.23 [1.12. 1.34]) and DBP with the risk of all-cause and CVD mortality (HRs [95% CIs]: 1.17 [1.11. 1.24] and 1.36 [1.26. 1.47]). We found linear associations of RHR, SBP, and DBP with all-cause and CVD mortality (P_{non-linearity} >0.05), except for the approximately J-shaped association between DBP and all-cause mortality (P_{non-linearity} = 0.008). There was a significant interaction of RHR and SBP with all-cause and CVD mortality (P_interaction <0.05).

CONCLUSIONS

RHR and BP increased the risk of all-cause and CVD mortality, especially fast RHR combined with high SBP.

PCovNet: A presymptomatic COVID-19 detection framework using deep learning model using wearables data

While the advanced diagnostic tools and healthcare management protocols have been struggling to contain the COVID-19 pandemic, the spread of the contagious viral pathogen before the symptom onset acted as the Achilles' heel. Although reverse transcription-polymerase chain reaction (RT-PCR) has been widely used for COVID-19 diagnosis, they are hardly administered before any visible symptom, which provokes rapid transmission. This study proposes PCovNet, a Long Short-term Memory Variational Autoencoder (LSTM-VAE)-based anomaly detection framework, to detect COVID-19 infection in the presymptomatic stage from the Resting Heart Rate (RHR) derived from the wearable devices, i.e., smartwatch or fitness tracker. The framework was trained and evaluated in two configurations on a publicly available wearable device dataset consisting of 25 COVID-positive individuals in the span of four months including their COVID-19 infection phase. The first configuration of the framework detected RHR abnormality with average Precision, Recall, and F-beta scores of 0.946, 0.234, and 0.918, respectively. However, the second configuration detected aberrant RHR in 100% of the subjects (25 out of 25) during the infectious period. Moreover, 80% of the subjects (20 out of 25) were detected during the presymptomatic stage. These findings prove the feasibility of using wearable devices with such a deep learning framework as a secondary diagnosis tool to circumvent the presymptomatic COVID-19 detection problem.

Associations between the rs5498 (A > G) and rs281432 (C > G) polymorphisms of the ICAM1 gene and atherosclerotic cardiovascular disease risk, including hypercholesterolemia

Background

Atherosclerotic cardiovascular disease (ASCVD) originates from complex risk factors, including age, gender, dyslipidemia, obesity, race, genetic and genetic variation. ICAM1 gene polymorphisms are a significant risk factor for ASCVD. However, the impact of the rs5498 and rs281432 polymorphisms on the prevalence of hypercholesterolemia (HCL) has not been reported. Therefore, we determine the relationships between single nucleotide polymorphisms (SNPs), including rs5498 and rs281432 on Intercellular adhesion molecule 1 gene (ICAM1) and ASCVD susceptibility in patients with HCL.

Methods

The clinical characteristics of 278 participants were assessed, and classified to groups having HCL and without HCL. ICAM1 SNPs genotyping was performed by DNA sequencing, and ICAM1 expression was measured using real-time PCR.

Results

Positive dominant model rs5498 participants had twice the risk of HCL (95% confidence interval (CI): [1.24-3.23], P = 0.005). The frequency of the G allele in rs5498 was 1.69 times higher in participants with HCL than in controls (95% CI [1.15-2.47], P = 0.007). Participants with the rs5498 AG or GG variants and high ICAM1 mRNA expression (≥3.12) had 2.49 times the risk (95% CI [1.42-4.38], P = 0.001), and those with a high LDL-C concentration (≥3.36 mmol/L) had 2.09 times the risk (95% CI [1.19-3.66], P = 0.010) of developing ASCVD compared with those with low ICAM1 mRNA and LDL-C levels. Interestingly, participants carrying the rs5498 AG or GG variants who had tachycardia (resting heart rates (RHRs) >100 beats/min) had a 5.02-times higher risk than those with a lower RHR (95% CI [1.35-18.63], P = 0.016).

Conclusions

It may consider the G allele in ICAM1 rs5498 is associated with a higher risk of ASCVD in Thai people with HCL, and is also positively associated with ICAM1 mRNA expression, LDL-C concentration, and RHR.

The predicting value of resting heart rate to identify undiagnosed diabetes in Korean adult: Korea National Health and Nutrition Examination Survey

OBJECTIVES

The purpose of this study was (1) to examine whether the addition of resting heart rate (RHR) to the existing undiagnosed diabetes mellitus (UnDM) prediction model would improve predictability, and (2) to develop and validate UnDM prediction models by using only easily assessable variables such as gender, RHR, age, and waist circumference (WC).

METHODS

Korea National Health and Nutrition Examination Survey (KNHANES) 2010, 2012, 2014, 2016 data were used to develop the model (model building set, n=19,675), while the data from 2011, 2013, 2015, 2017 were used to validate the model (validation set, n=19,917). UnDM was defined as a fasting glucose level ≥126 mg/dL or glycated hemoglobin ≥6.5%; however, doctors have not diagnosed it. Statistical package for the social sciences logistic regression analysis was used to determine the predictors of UnDM.

RESULTS

RHR, age, and WC were associated with UnDM. When RHR was added to the existing model, sensitivity was reduced (86 vs. 73%), specificity was increased (49 vs. 65%), and a higher Youden index (35 vs. 38) was expressed. When only gender, RHR, age, and WC were used in the model, a sensitivity, specificity, and Youden index of 70%, 67%, and 37, respectively, were observed.

CONCLUSIONS

Adding RHR to the existing UnDM prediction model improved specificity and the Youden index. Furthermore, when the prediction model only used gender, RHR, age, and WC, the outcomes were not inferior to those of the existing prediction model.

Increased resting heart rate and glucose metabolism in a community population

Objective

Resting heart rate (RHR) independently predicts cardiovascular death. Increased RHR is related to chronic diseases, but community-based studies are rare. We investigated this population and factors related to RHR.

Methods

In total, 374 participants underwent medical examinations from March 2019 to December 2019. Participants were divided into groups with low RHR (LRHR; <65 beats/minute) and high RHR (HRHR; ≥65 beats/minute). RHR was judged using resting electrocardiogram at physical examination. We conducted laboratory examinations, including glycosylated hemoglobin (HbA1c), fasting plasma glucose (FPG), and blood lipids, among participants with chronic diseases. We used Cox proportional risk regression and multivariate analyses for the following covariates: previous chronic diseases, body mass index (BMI), smoking, blood lipids, and FPG.

Results

The incidence of type 2 diabetes mellitus (T2DM) and HbA1c values were both significantly higher in the HRHR group than in the LRHR group. Spearman correlation analysis showed RHR had a positive correlation with low-density lipoprotein, BMI, FPG, and HbA1c (r = 0.104574, 0.117266, 0.116041, and 0.311761, respectively). Multiple linear regression analysis showed age, hypertension, T2DM, and HbA1c were factors influencing RHR.

Conclusion

RHR showed strong correlation with T2DM and HbA1c in our community population, suggesting that RHR may be a risk factor for cardiovascular disease.

Early-pregnancy maternal heart rate is related to gestational diabetes mellitus (GDM)

OBJECTIVE

The study examined the association between resting heart rate (RHR) of early pregnancy and risk of gestational diabetes mellitus (GDM) in Chinese population.

METHODS

As retrospective study, medical data of 15,092 pregnant women gave birth in 2019 was collected and analyzed. The pregnant women's age, educational level, pre-pregnancy body weight, height, parity, family history of diabetes, lipid profile, blood pressure and RHR were recorded during 11 ∼ 13⁺⁶ weeks. Multivariate logistic regression analysis was used to estimate the association between maternal characteristics and RHR and GDM. And we further evaluated the predictive roll of RHR in different sub-groups defined by their body mass index (BMI), age, fasting plasma glucose (FPG), total cholesterol and triglyceride.

RESULTS

2313 women (15.33%) were diagnosed as GDM according to 75 g OGTT. According to the quartile value of RHR, the subjects were divided into four groups. Risk of GDM increased significantly as RHR increased. In the fully adjusted model, ORs(95%CI) for the lowest vs highest quartiles of heart rate were 1(as reference), 1.14(0.97 ∼ 1.33), 1.25(1.05 ∼ 1.40), 1.41(1.21 ∼ 1.62), respectively. In the subgroup's analysis, we found the relationship between RHR and risk of GDM was evident in women with low and normal BMI; with normal fasting plasma; and normal serum lipid level.

CONCLUSION

The current study shows early-pregnancy maternal RHR is associated with potential risk of developing GDM.

Predictors of improvement in resting heart rate after exercise training in patients with chronic obstructive pulmonary disease

BACKGROUND

High resting heart rate (RHR) is associated with multiple morbidity in chronic obstructive pulmonary disease (COPD) patients. Factors regarding the effectiveness of exercise training (ET) on RHR in COPD patients are unclear.

AIMS

The main objective of the current study is to determine the predictors of the eventual change in RHR after ET.

METHODS

One hundred and ten COPD patients (mean age: 63.1 ± 8.1 years, FEV1%: 43.6 ± 16.6) who participated in the ET program that consisted of supervised breathing, aerobic, strengthening, and stretching exercises for 8 weeks, 2 days a week, were included in the study. RHR, pulmonary functions, 6-min walk distance (6-MWD), Modified Medical Research Council Dyspnea Scale, St. George Respiratory Questionnaire, and Hospital Anxiety and Depression scores were compared before and after ET. Multivariate regression analysis was performed to correlate factors related to changes in RHR before and after exercise.

RESULTS

There was a significant improvement in RHR after the ET program (p < 0.001). Improvement in RHR was correlated with baseline RHR, 6-MWD, partial arterial oxygen pressure, dyspnea sensation, forced expiratory volume in the first second (r = 0.516, -0.388, -0.489, 0.369, -0.360, p < 0.05, respectively), and change in 6-MWD, partial arterial oxygen pressure, and symptom score (r = 0.523, 0.451, -0.325, p < 0.05, respectively) after ET. Baseline RHR, 6-MWD, and the change in 6-MWD were the independent factors that predicted the change in RHR after ET.

CONCLUSIONS

Patients with a high RHR and low functional capacity and whose functional capacity improves more have a greater decrease in RHR after the ET program. By considering these related factors, clinicians can focus on improving the cardiovascular system in COPD patients.

CLINICAL TRIAL NUMBER

NCT04890080 (retrospectively registered-date of registration: 05.17.2021).

Efficacy of estimating VO2max with the Heart Rate Ratio Method in middle-aged and older adults

PURPOSE

Investigate difference, agreement, and bias between maximal oxygen consumption (VO₂max) measured by indirect calorimetry and the Heart Rate Ratio Method (HRRM) for estimating VO₂max using measured and age-predicted maximum heart rate (HRmax) in a sample of middle-aged and older adults.

METHODS

Eleven men and nine women (age: 61.8 ± 8.5 years, VO₂max: 36.6 ± 9.5 mL/kg/min, N = 20) had their VO₂max measured via a maximal graded exercise test and confirmed using a verification bout on a treadmill ergometer. Participants' VO₂max was estimated via the HRRM using measured and age-predicted HRmax. Difference, agreement, and bias between methods were assessed using a one-way repeated measures Analysis of Variance (ANOVA), Lin's concordance correlation coefficient, and Bland-Altman plots, respectively.

RESULTS

There were no statistical differences between methods of assessing VO₂max, F(1.13, 21.47) = 0.583, p = 0.473, generalized eta-squared = 0.012. The standard error of the estimate (SEE) for the HRRM using measured or predicted HRmax was 5.2% and 5.6% of the mean VO₂max, respectively. Both HRRM predictions had poor agreement with VO₂max (r_c ≤ 0.40). There was a systematic bias to underestimate as VO₂max increased for HRRM using measured HRmax, F(1, 18) = 17.40, p < 0.001, and when using an age-predicted HRmax, F(1, 18) = 13.39, p = 0.002.

CONCLUSION

Both versions of the HRRM have poor agreement, relatively large SEEs, and a bias to misrepresent VO₂max. When possible, VO₂max should be measured via a maximal graded exercise test with indirect calorimetry for middle-aged and older adults.

Resting Heart Rate Mediates the Relationship between Parenting Style and Callous-Unemotional Traits in Chinese Children

Despite increasing knowledge of social and biological risk factors for callous-unemotional (CU) traits, relatively less is known about how these two sets of risk factors combine to affect these traits. The current longitudinal study investigated pathways from parenting style to CU traits via resting heart rate in a three-year project. Parents of 382 children completed the Parenting Styles and Dimensions Questionnaire at Time 1 (children Mean age = 9.06, SD = 0.94, range = 7-11 years), with the heart rate data collected at Time 2 (M = 10.16, SD = 0.93, range = 8-13 years) and CU traits assessed at Time 3 (M = 11.06, SD = 0.94, range = 9-13 years). We found that parenting style and CU traits were associated with resting heart rate, and that structural equation modeling showed resting heart rate to partially mediate the effect of parenting style on CU traits. Specifically, higher levels of authoritarian parenting were associated with lower resting heart rate, which in turn was linked to higher level of CU traits. On the contrary, children in the context of authoritative parenting showed relatively higher resting heart rate, which was predictive of lower CU traits. Overall, findings have implications for understanding the etiology of CU traits in children and developing effective prevention programs for children with affective deficits.

Blood lead and mercury levels are associated with low resting heart rate in community adolescent boys

While the neurotoxic effects of heavy metals at even low levels have been well-studied, few studies have examined the cardiovascular effects of heavy metals on resting heart rate and these have focused on adult populations. The present study aimed to examine the association between low-level environmental lead and mercury exposure and resting heart rate in community adolescents. As part of the China Jintan Cohort Study, 532 adolescents aged 12 years (SD = 0.6) were tested for blood levels of lead (BLL) and mercury (BML) and resting heart rate (RHR). Generalized linear models were conducted to test the relationship between BLL and BML and RHR, controlling for children's sex, age, and socioeconomic status. Analyses were clustered at the preschool level when the children were recruited to adjust for standard error. The mean (SD) BLL and BML were 3.14 (SD = 1.19) μg/dL and 1.26 (SD = 0.68) μg/L at age 12 years, respectively. After adjusting for confounders, we found a significant interaction between BML and BLL in predicting RHR in boys (B = -1.27, SE = 0.49, p < 0.01, n = 289). We created BLL and BML groups in boys based on median cut-offs. Boys in the High BLL/High BML group had significantly lower RHR (mean = 84.22 beats per minute [bpm], SD = 8.77, n = 61) than boys in the Low BLL/Low BML group (mean = 89.03 bpm, SD = 10.75, n = 69; p < 0.05). BML and BLL did not interact to predict RHR in girls (B = -0.18, SE = 0.88, p > 0.05, n = 242). Combined high BLL and BML were associated with low RHR in community adolescent boys. Low RHR is an indication of chronic under-arousal and has been implicated in psychopathology, particularly for externalizing behavior. Our findings may stimulate further communication and research in this area.

Sex-specific association of resting heart rate with type 2 diabetes mellitus

AIM

This study aimed to explore the association of resting heart rate (RHR) with type 2 diabetes mellitus (T2DM) by sex, and whether the association was mediated by insulin resistance (IR).

METHODS

This cross-sectional study enrolled 12,508 participants (median age 57 years), with information collection through questionnaire interview, anthropometric and laboratory measurements. Multivariable logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) of the association between RHR and T2DM by sex, and restricted cubic splines were used to describe the dose-response association. Mediation analysis was used to explore the contribution of IR, measured by homeostasis model assessment of insulin resistance (HOMA-IR) index, to RHR-related T2DM.

RESULTS

Among 12,508 participants, 1413 participants (11.30%) had T2DM. RHR was positively associated with T2DM (per 10-bpm increase in RHR, OR 1.48, 95% CI: 1.34-1.64 for men and OR 1.42, 95% CI: 1.32-1.52 for women). As compared with RHR = 75 bpm, with increasing RHR, the adjusted probability of T2DM was significantly increased for both men and women. HOMA-IR partially mediated the association (indirect effect: OR = 1.17, 95% CI:1.13-1.22; direct effect: OR = 1.25, 95% CI: 1.11-1.39 in men and indirect effect: OR = 1.16, 95% CI:1.13-1.20; direct effect: OR = 1.15, 95% CI: 1.15-1.35 in women).

CONCLUSION

RHR was significantly associated with T2DM, which suggests that RHR may be a non-invasive clinical marker of early intervention to prevent T2DM, and IR may partially mediated RHR-related T2DM.

The importance of cardiorespiratory fitness and sleep duration in early CVD prevention: BMI, resting heart rate and questions about sleep patterns are suggested in risk assessment of young adults, 18-25 years : The cross-sectional lifestyle, biomarkers and atherosclerosis (LBA) study

Background

Cardiorespiratory fitness (CRF) and sleep habits are lifestyle factors with potential to prevent cardiovascular disease (CVD). CVD is the leading cause of death worldwide. It is therefore important to establish a healthy lifestyle at a young age. In the Lifestyle, Biomarkers and Atherosclerosis (LBA) study we have examined 834 healthy non-smoking adults, aged 18–25 years. The general purpose of the LBA study was to study the effect of lifestyle on traditional biomarkers known to influence CVD risk. The aims of the present study were to evaluate sleep habits of young adult women and men participating in the LBA study, and to compare the importance of sleep and other lifestyle habits on clinically relevant biomarkers for CVD. An additional aim was to find easy and reliable non-invasive biomarkers to detect young adults with increased risk of developing CVD later in life.

Methods

The participants had previously been examined for lifestyle factors, biomarkers and CVD risk score. They filled in a validated computerized questionnaire about their general physical and mental health. The questionnaire included questions on sleep duration and experienced quality of sleep.

Results

In total 27% of the young adult participants reported difficulties falling asleep or experienced troubled sleep with frequent awakenings per night. The experienced troubled sleep was not related to a higher CVD risk score, but sleep quality and duration were correlated. Shorter sleep duration was significantly associated to higher body mass index (BMI), body fat (%), homeostasis model assessment of insulin resistance (HOMA-IR) and CVD risk. The modifiable lifestyle factor with the highest odds ratio (OR) for CVD risk was CRF. Sleep duration was the second most influential lifestyle factor, more important than moderate- and vigorous physical activity (MVPA) and food habits. Correlations between CRF and heart rate (HR), (P < 0.01) and HOMA-IR and BMI (P < 0.01) were observed, indicating that BMI and resting HR in combination with questions about sleep patterns are easy and reliable non-invasive biomarkers to detect young adults who need counselling on a healthy lifestyle.

Conclusion

Decreased sleep duration in combination with decreased CRF, in young adults, is a serious health issue.

[Tumor effects on the heart and circulation]

As a result of the continuous development of modern cancer treatment, more cancer patients can be cured every year. However, since many patients experience cardiovascular problems before, during and after their cancer treatment, cardio-oncology is becoming increasingly important. Numerous therapies can cause cardiotoxicity, such as chemotherapy, immunotherapy, antibody therapy and radiotherapy. If these remain undetected, the patient may develop, e.g. heart failure or severe heart valve damage. The broad spectrum of cardiovascular comorbidities has become an immense challenge for cardiologists and oncologists. Cardio-oncology also deals with the effects that cancer has on the cardiovascular system. New research indicates that the tumor itself also has direct negative effects on the heart, mediated by messenger substances. Therefore, it is important to understand which cancer patients are at increased cardiovascular risk, thereby enabling the development of new therapeutic approaches in the long term to maintain mobility and improve patient prognosis.

[Bivariate heritability estimation of resting heart rate and common chronic disease based on extended pedigrees]

OBJECTIVE

To estimate the univariate heritability of resting heart rate and common chronic disease such as hypertension, diabetes, and dyslipidemia based on extended pedigrees in Fujian Tulou area and to explore bivariate heritability to test for the genetic correlation between resting heart rate and other relative phenotypes.

METHODS

The study was conducted in Tulou area of Nanjing County, Fujian Province from August 2015 to December 2017. The participants were residents with Zhang surname and their relatives from Taxia Village, Qujiang Village, and Nanou Village or residents with Chen surname and their relatives from Caoban Village, Tumei Village, and Beiling Village. The baseline survey recruited 1 563 family members from 452 extended pedigrees. The pedigree reconstruction was based on the family information registration and the genealogy booklet. Univariate and bivariate heritability was estimated using variance component models for continuous variables, and susceptibility-threshold model for binary variables.

RESULTS

The pedigree reconstruction identified 1 seven-generation pedigree, 2 five-generation pedigrees, 23 four-generation pedigrees, 186 three-generation pedigrees, and 240 two-generation pedigrees. The mean age of the participants was 57.2 years and the males accounted for 39.4%. The prevalence of hypertension, diabetes, dyslipidemia in this population was 49.2%, 10.0%, and 45.2%, respectively. The univariate heritability estimation of resting heart rate, hypertension, and dyslipidemia was 0.263 (95%CI: 0.120－0.407), 0.404 (95%CI: 0.135－0.673), and 0.799 (95%CI: 0.590－1), respectively. The heritability of systolic blood pressure, diastolic blood pressure, fasting glucose, total cholesterol, triglyceride, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol was 0.379, 0.306, 0.393, 0.452, 0.568, 0.852, and 0.387, respectively. In bivariate analysis, there were phenotypic correlations between resting heart rate with hypertension, diabetes, diastolic blood pressure, fasting glucose, and triglyceride. After taking resting heart rate into account, there were strong genetic correlations between resting heart rate with fasting glucose (genetic correlation 0.485, 95%CI: 0.120－1, P<0.05) and diabetes (genetic correlation 0.795, 95%CI: 0.181－0.788, P<0.05).

CONCLUSION

Resting heart rate was a heritable trait and correlated with several common chronic diseases and related traits. There was strong genetic correlation between resting heart rate with fasting glucose and diabetes, suggesting that they may share common genetic risk factors.

Correlation of resting heart rate with anthropometric factors and serum biomarkers in a population-based study: Fasa PERSIAN cohort study

Background

There is a positive association between raised resting heart rate (RHR), and all causes of mortality and shorter life expectancy. Several serum biomarkers and some anthropometric factors can affect the resting heart rate. This study aimed to investigate the determinants of resting heart rate in a large random sample of the Iranian population.

Material and methods

It is a standardized, retrospective study and the subjects were chosen from the baseline survey of the Prospective Epidemiological Research Study in IrAN (PERSIAN) Fasa non-communicable disease cohort study. It was conducted from winter 2014 to summer 2019 and after obtaining informed consent from a random sample, all the eligible subjects were enrolled. All anthropometric factors and biologic laboratory factors were collected and analyzed by implement smoothly clipped absolute deviation (SCAD) linear regression and SCAD quantile regression. The comparisons between males and females were done via independent T-test.

Results & conclusion

A total number of 9975 persons from 35 to 90 years old were included. The overall median resting heart rate was 74 (interquartile range:66–80). Mean age has no important difference between males and females (P = 0.79) but, resting heart rate was significantly higher in females (76.6 versus 71.4, P < 0.001). All anthropometric factors except wrist circumference were higher in females (P < 0.05). Age has an adverse effect on resting heart rate and also, there was a direct association between resting heart rate and systolic blood pressure and blood glucose. Alpha-blockers (coefficient = 5.2) and Beta1-blockers (coefficient = − 2.2) were the most effective drugs with positive and negative effects on resting heart rate respectively. Lower hemoglobin, obesity, and more body mass index, and more low-density lipoprotein were associated with more resting heart rate.

Continuing the monitoring of this sample via our cohort study and put to action multinational prospective researches with large sample sizes and long follow-ups can lead to more precise results and better scientific judgments.

[A cohort study on the association between resting heart rate and the risk of new-onset heart failure]

Objective: To prospectively explore the relationship between resting heart rate (RHR) and risk of new-onset heart failure. Methods: It was a prospective cohort study. People who attended the physical examination of Kailuan Group Company in 2006 and with complete electrocardiography (ECG) recordings were eligible for this study. A total of 88 879 participants aged 18 years old or more who were free of arrhythmia, a prior history of heart failure and were not treated with β-blocker were included. Participants were divided into 5 groups according to the quintiles of RHR at baseline (Q(1) group, 40-60 beats/minutes (n=18 168) ; Q(2) group, 67-70 beats/minutes (n=18 970) ; Q(3) group, 71-74 beats/minutes (n=13 583) ; Q(4) group, 75-80 beats/minutes (n=22 739) ; and Q(5) group,>80 beats/minutes (n=15 419) ) .The general clinical data and laboratory test results were collected. The outcome was the first occurrence of heart failure at the end of follow-up (December 31, 2016) .We used Cox regression model to examine the association between RHR and the risk of new-onset heart failure. Hazard ratio (HR) with 95% confidence intervals (CI) were calculated using Cox regression modeling. Results: Among the included patients 68 411 participants were male, mean age was (51.0±12.3) years old, and RHR was (74±10) beats/minutes. Statistically significant differences among the RHR quintiles were found for the following variables: age, gender, systolic blood pressure, diastolic blood pressure, triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, fasting blood glucose, body mass index, the level of high-sensitivity C-reactive protein, education status, physical activity, smoking status, drinking status, history of diabetes, history of hypertension and history of use antihypertensive drugs (all P<0.01) . Higher RHR was linked with higher prevalence of diabetes, hypertension history, and higher systolic blood pressure, diastolic blood pressure and FBG levels (all P<0.01). After a mean follow-up of 9.5 years, the incidence of new-onset heart failure in Q(1), Q(2), Q(3), Q(4) and Q(5) groups was 1.60%(290/18 168), 1.36%(258/18 970), 1.80%(245/13 583), 1.76%(400/22 739) and 2.35%(362/15 419),respectively (P<0.01) . The person-year incidence of heart failure in Q(1), Q(2), Q(3), Q(4) and Q(5) groups was 1.7, 1.5, 1.9, 1.9 and 2.6 per 1 000 person-years respectively. Compared with the Q(2) group, multivariate analysis with adjustment for major traditional cardiovascular risk factors showed that HRs of Q(3),Q(4),and Q(5) group were 1.23 (95%CI 1.03-1.48, P<0.05) , 1.19 (95%CI 1.01-1.41, P<0.05) , 1.39 (95%CI 1.18-1.65, P<0.01) , respectively. In the absence of hypertension, diabetes, smoking and acute myocardial infarction, the Cox regression model showed that compared with Q(2) group, the HR of new-onset heart failure in Q(5) group was 1.58 (95%CI 1.02-2.45, P<0.05) . Conclusion: Increased RHR is associated with increased risk of new-onset heart failure in this cohort.

Association of heart rate trajectories with the risk of adverse outcomes in a community-based cohort in Taiwan

Heart rate trajectory patterns integrate information regarding multiple heart rate measurements and their changes with time. Different heart rate patterns may exist in one population, and these are associated with different outcomes. Our study investigated the association of adverse outcomes with heart rate trajectory patterns. This was a prospective cohort study based on the Chin-Shan Community Cardiovascular Cohort in Taiwan. A total of 3,015 Chinese community residents aged > 35 years were enrolled in a prospective investigation of cardiovascular risk factors and outcomes from 1990 to 2013.The primary outcome was all-cause mortality, and the secondary outcome was a composite of coronary artery disease and cerebrovascular accidents. The following trajectory patterns were identified: stable, 61%; decreased, 5%; mildly increased, 32%; and markedly increased, 2%. During follow-up (median, 13.9 years), 557 participants died and 217 experienced secondary outcomes. The adjusted hazard ratios of primary and secondary outcomes for participants with a markedly increased trajectory pattern were 1.80 (95% CI [1.18-2.76]) and 1.45 (95% CI [0.67-3.12]), respectively, compared to those for participants with a stable trajectory pattern. A markedly increased heart rate trajectory pattern may be associated with all-cause mortality risks. Heart rate trajectory patterns demonstrated the utility of repeated heart rate measurements for risk assessment.

Elevated resting heart rate in adolescent men and risk of heart failure and cardiomyopathy

Aims

This study aims to investigate the association of resting heart rate (RHR) measured in late adolescence with long‐term risk of cause‐specific heart failure (HF) and subtypes of cardiomyopathy (CM), with special attention to cardiorespiratory fitness.

Methods and results

We performed a nation‐wide, register‐based cohort study of all Swedish men enrolled for conscription in 1968–2005 (n = 1 008 363; mean age = 18.3 years). RHR and arterial blood pressure were measured together with anthropometrics as part of the enlistment protocol. HF and its concomitant diagnoses, as well as all CM diagnoses, were collected from the national inpatient, outpatient, and cause of death registries. Risk estimates were calculated by Cox‐proportional hazards models while adjusting for potential confounders. During follow‐up, there were 8400 cases of first hospitalization for HF and 3377 for CM. Comparing the first and fifth quintiles of the RHR distribution, the hazard ratio (HR) for HF associated with coronary heart disease, diabetes, or hypertension was 1.25 [95% confidence interval (CI) = 1.13–1.38] after adjustment for body mass index, blood pressure, and cardiorespiratory fitness. The corresponding HR was 1.43 (CI = 1.08–1.90) for HF associated with CM and 1.34 (CI = 1.16–1.54) for HF without concomitant diagnosis. There was an association between RHR and dilated CM [HR = 1.47 (CI = 1.27–1.71)] but not hypertrophic, alcohol/drug‐induced, or other cardiomyopathies.

Conclusions

Adolescent RHR is associated with future risk of HF, regardless of associated aetiological condition. The association was strongest for HF associated with CM, driven by the association with dilated CM. These findings indicate a causal pathway between elevated RHR and myocardial dysfunction that warrants further investigation.

Resting Heart Rate and In-Hospital Mortality in Acute Ischemic Stroke Patients With and Without Atrial Fibrillation

BACKGROUND

The prognostic role of resting heart rate (RHR) on mortality in acute ischemic stroke (AIS) patients including atrial fibrillation (AF) is unclear. This study evaluated the relationship between RHR and in-hospital mortality among all AIS patients with and without AF.Methods and Results:The study enrolled 3,447 AIS patients from December 2013 to May 2014 across 22 hospitals in Suzhou City. Patients were divided into 2 groups based on median baseline RHR (<76 and ≥76 beats/min). Cox proportional hazard regression models were used to estimate the effects of RHR on all-cause in-hospital mortality. During hospitalization, 124 patients (3.6%) died from all causes. A multivariable model adjusted for potential covariates showed that higher RHR (≥76 beats/min) was associated with an increase in the risk of in-hospital mortality among AIS patients (hazard ratio [HR] 1.63; 95% confidence interval [CI] 1.09-2.45; P=0.018). This relationship was consistent in a subgroup analysis of patients without AF (HR 2.39; 95% CI 1.29-4.45; P=0.006). However, there was no significant association between higher RHR and in-hospital mortality among patients with AF (P=0.654). Similar findings were confirmed in analyses with heart rate as a continuous variable.

CONCLUSIONS

Higher RHR at admission was independently associated with in-hospital mortality in AIS patients without AF.

Increased resting heart rate and prognosis in treatment-naïve unselected cancer patients: results from a prospective observational study

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.

Heart rate as cardiovascular risk factor

Heart rate is a parameter that is widely used by the general population as a marker of health. The availability of wearable electronic heart rate monitoring devices and use of specific apps are widely used both at rest and during daily life activities. Resting heart rate values gained more relevance with the evidence of association between elevated heart rate values at rest and diseases and adverse events. Also longitudinal studies demonstrated a clear association between increase in heart rate over time and cardiovascular and all-cause mortality. The increased knowledge of physiological mechanisms of heart rate control and the pathophysiological mechanisms responsible for its dysfunction allows identification of the cutoff value of normalcy. This information can be used to select non-pharmacological and pharmacological interventions to reduce the cardiovascular risk both in the general population and in patients with pathophysiological conditions. This review provides an overview of the current knowledge of resting heart rate as cardiovascular risk factor.

Is physical activity associated with resting heart rate in boys and girls? A representative study controlled for confounders

OBJECTIVE

Investigate the relationship between different domains of physical activity and resting heart rate (RHR) in boys and girls.

METHOD

The sample included 1011 adolescents, aged between 10 and 17 years. RHR was measured by a heart rate monitor and physical activity was assessed in total and in three different domains (school, occupational, and sports practice) by a questionnaire. Anthropometry was directly obtained for body mass index and central fat. Ethnicity, sedentary behavior, and smoking habits were self-reported and used to adjust the analysis, through hierarchical linear regression.

RESULTS

Total physical activity was associated with low RHR in boys (β=-0.52; 95% CI: -0.92, -0.12) and girls (β=-0.67; 95% CI: -1.07, -0.28). Although sporting physical activities were associated with low RHR in both boys (β=-0.58; 95% CI: -1.05, -0.11) and girls (β=-0.87; 95% CI: -1.34, -0.39), occupational physical activity was related to low RHR only in boys (β=-1.56; 95% CI: -2.99, -0.14).

CONCLUSION

The practice of physical activity in the sport practice domain and total physical activity were related to low RHR in both sexes, while occupational physical activities were associated with RHR only in boys.

[The sex- and age-specific association between resting heart rate and hypertension in rural adult residents of Henan province]

Objective: To investigate the sex- and age-specific association between resting heart rate and hypertension in rural adult residents of Henan province. Methods: At baseline, a total of 20 194 participants were randomly selected from Xin'an County of Henan province between July 2007 and August 2008. After excluding participants with hypertension or without resting heart rate data at baseline, and participants died or without hypertension outcome or diagnosed as gestational hypertension during follow-up between July 2013 and October 2014, 10 212 participants were finally included in this study. Multiple linear regression model was used to examine the association between resting heart rate and change of blood pressure. Logistic regression model was used to estimate the association between resting heart rate and risk of hypertension. Results: There were 2 059 new hypertensive cases (839 male) during the 6 years follow-up. After controlling for potential confounders, per 5 beats/minutes increases in resting heart rate was associated with 0.18 mmHg (1 mmHg=0.133 kPa) (95%CI 0.01-0.36 mmHg, P=0.046) absolute increase in systolic blood pressure and 7% higher risk of developing hypertension in women (95%CI 1.03-1.11, P<0.05). Compared with resting heart rate<70 beats/minutes, the adjusted RRs for 76-82 and>82 beats/minutes groups were 1.39 (95%CI 1.18-1.63, P<0.05) and 1.22 (95%CI 1.02-1.45, P<0.05), respectively. For both age groups, increased resting heart rate was positively associated with risk of hypertension in women(RR=1.05(95% CI 1.01-1.10), P<0.05 (the women those <60 years); RR=1.14(95% CI 1.04-1.25), P<0.05 (the women those≥60 years). However, no significant association was found between resting heart rate and hypertension in male residents. Conclusions: Increased resting heart rate is associated with high risk of hypertension in women who live in rural area, especially in elder women of this cohort.

Ideal cardiovascular health and resting heart rate in the Multi-Ethnic Study of Atherosclerosis

Elevated resting heart rate (RHR) is associated with an increased cardiovascular disease (CVD) risk, but little is known about its association with cardiovascular health (CVH), assessed by the Life's Simple 7 (LS7) metrics. We explored whether ideal CVH was associated with RHR in a cohort free from clinical CVD. We conducted a cross-sectional analysis of baseline data (2000-2002) of 6457 Multi-Ethnic Study of Atherosclerosis participants in 2018. Each LS7 metric (smoking, physical activity, diet, body mass index, blood pressure, cholesterol and glucose) was scored 0-2. Total score ranged from 0 to 14. Scores of 0-8 indicate inadequate, 9-10 average, and 11-14 optimal CVH. RHR was categorized as <60, 60-69, 70-79 and ≥80 bpm. We used multinomial logistic regression to determine associations between CVH score and RHR, adjusting for age, sex, race/ethnicity, education, income, health insurance, and atrioventricular nodal blockers. Mean age of participants (standard deviation) was 62 (10) years; 53% were women; 47% had inadequate CVH, 33% average, and 20% optimal. Favorable CVH was associated with lower odds of having higher RHR. Compared to RHR <60 bpm, participants with optimal CVH had adjusted odds ratio (95% CI) of 0.55 (0.46-0.64) for RHR of 60-69 bpm, 0.34 (0.28-0.43) for 70-79 bpm, and 0.14 (0.09-0.22) for ≥80 bpm. A similar pattern was observed in the stratified analysis by sex, race/ethnicity and age. Favorable CVH was less likely to be associated with elevated RHR irrespective of sex, race/ethnicity and age. More research is needed to explore the usefulness of promoting ideal CVH to reduce elevated RHR, a known risk factor for CVD.

Association between resting heart rate and incident diabetes risk: a Mendelian randomization study

AIMS

Observational studies indicated that resting heart rate (RHR) was associated with diabetes mellitus (DM) risk; however, it remains unclear whether the association between RHR and DM is causal. We aimed to examine whether there was causal association of RHR with DM risk.

METHODS

A prospective study including 16,201 middle-aged and older Chinese (7031 males and 9170 females) derived from the Dongfeng-Tongji cohort was performed. Cox proportional hazard regression models were conducted to estimate the associations between RHR and incident DM risk. In 7481 participants, 65 single nucleotide polymorphisms related to RHR were genotyped. A genetic risk score (GRS) of RHR was calculated based on the RHR-associated variants. The causal associations of RHR with DM risk were investigated by Mendelian randomization analysis.

RESULTS

During a mean (SD) follow-up of 4.5 (0.5) years, 1110 diabetes were identified. Compared with the referential RHR group (≤ 60 beats per minute [bpm]), individuals with RHR > 80 bpm have a higher incident diabetes risk, with a hazard ratio of 1.40 (95% confidence interval [CI], 1.05-1.88). With per SD increase in the weighted genetic risk score, the resting heart rate increased by 0.71 bpm (95% CI 0.49-0.93). By using the GRS to estimate the unconfounded effect, we found that higher resting heart rate did not have a causal effect on diabetes risk (OR 1.00 [95% CI 0.95-1.05]).

CONCLUSIONS

The present study supported a positive but not a causal association of RHR with incident diabetes risk. More studies are needed to verify our findings.

Association between resting heart rate, VO2max and carotid intima-media thickness in middle-aged men

Introduction

Low resting heart rate (RHR) and high cardiorespiratory fitness (VO₂max) are associated with a reduction in cardiovascular events (CV). Carotid intima-media thickness (CIMT) has been suggested as a predictor of CV. The purpose of this study was to investigate the association between RHR, VO₂max and CIMT.

Methods

The subjects of this study were 707 males aged 40–50 who visited the National Health Center of South Korea, a health examination institution, from 2010 to 2016. RHR was measured using electrocardiogram. RHR was divided into 4 levels (<60 beats per minute; bpm, 60–69 bpm, 70–79 bpm, ≥80 bpm). VO₂max was measured by grade exercise test. Subject's VO₂max was divided into 3 levels (first, second and third tertiles). CIMT was measured by B-mode ultrasound. Carotid atherosclerosis was defined as CIMT >1 mm.

Results

There was no significant difference in CIMT according to RHR level and there was no correlation between RHR and CIMT. High and middle VO₂max group had significant lower CIMT than low VO₂max group (P < 0.001). There was also a correlation between VO₂max and CIMT (R = −0.129, P < 0.001). The low VO₂max group showed 3.56-fold (95% CI, 1.77–7.16) higher relative risk of carotid atherosclerosis than the high VO₂max group.

Conclusion

These results suggest that cardiovascular fitness index VO₂max is associated to CIMT in middle-aged men. In addition, this study shows that VO₂max are important indicators for the prevalence of carotid atherosclerosis.

6-year change in resting heart rate is associated with incident type 2 diabetes mellitus

BACKGROUND AND AIMS

Elevated resting heart rate (RHR) is associated with risk of type 2 diabetes mellitus (T2DM). However, the association of change in RHR (ΔRHR) and incident T2DM is not fully elucidated. We aimed to assess the dose-response association between 6-year ΔRHR and T2DM.

METHODS AND RESULTS

A total of 12155 non-T2DM participants ≥18 years old were enrolled during 2007-2008 and followed up during 2013-2014. ΔRHR was calculated by subtracting the baseline RHR from the RHR value at 6-year follow-up. Age-, sex-, and RHR-specific relative risks (RRs) and 95% confidence intervals (CIs) for the effect of ΔRHR on incident T2DM were calculated by using modified Poisson regression models. As compared with ΔRHR of 0 beats/min, the adjusted risk of T2DM was significantly increased with RHR increment and reduced with RHR reduction. ΔRHR was positively associated with future risk of T2DM [RR per unit increase: 1.03 (1.03-1.04)]. As compared with stable change in RHR group (-5<ΔRHR<5 beats/min), for ΔRHR ≤ -10 beats/min, -10<ΔRHR ≤ -5 beats/min, 5≤ΔRHR<10 beats/min, and ΔRHR ≥10 beats/min groups, the pooled adjusted RR (95% CI) of T2DM was 0.69 (0.55-0.86), 0.90 (0.73-1.11), 1.31 (1.07-1.61), and 1.90 (1.59-2.26), respectively. This significant association still existed on subgroup analyses based on age, sex, and baseline RHR and sensitivity analyses.

CONCLUSIONS

Dynamic RHR change was significantly associated with incident T2DM. Our study suggests that RHR may be a non-invasive clinical indicator for interventions aiming to reduce incident T2DM in the general population.

Occurrence of composite cardiac endpoints with change in resting heart rate among Chinese patients with coronary artery disease: Chinese cohort from the real-world BISO-CAD study

OBJECTIVE

We evaluated change in resting heart rate (RHR) and its impact on prognosis in Chinese coronary artery disease (CAD) patients treated with bisoprolol, and also assessed drug safety and tolerability.

METHODS

This phase IV, single arm observational study was a sub-study of the BISO-CAD study conducted across 20 hospitals in China between October 2011 and July 2015 with follow-up at 6, 12 and 18 months after baseline. The primary endpoint was occurrence of composite cardiac events.

RESULTS

A total of 663 CAD patients (baseline RHR 75.47 ± 6.62 bpm) were enrolled in the intent-to-treat (ITT) set, and 513 patients were included in the efficacy analysis (EA) set. In the ITT set, the risk and the number of composite cardiac events in patients with mean RHR 69-74 bpm were significantly higher than in the <65 bpm group (ITT: estimate 1.03 ± 0.47, p = .029). The incidence of the composite cardiac endpoint was not affected by continuous mean RHR (p = .5070). RHR significantly decreased from baseline to 18 months, most obviously in the first 6 months (p < .0001). Ejection fraction and fractional shortening significantly improved in both the ITT and EA sets. An average RHR of 69-74 bpm had a significant effect on admission to hospital for acute coronary syndrome in the ITT (estimate 1.10, HR 3.004, p = .0196) and EA (estimate 1.26, HR 3.526, p = .0132) groups. Seven (1.1%) patients reported drug related adverse events.

CONCLUSION

Reduction in RHR with bisoprolol lowered the incidence of composite cardiac events along with an acceptable safety and tolerability profile.

Resting heart rate in late adolescence and long term risk of cardiovascular disease in Swedish men

AIM

To investigate the association of resting heart rate (RHR) measured in late adolescence with the long term risk of myocardial infarction (MI), ischemic stroke (IS), heart failure (HF), atrial fibrillation (AF), cardiovascular- and all-cause death.

METHODS AND RESULTS

We followed a cohort of Swedish men enrolled for conscription in 1968-2005 (n = 1,008,485; mean age = 18.3 years) until December 2014. Outcomes were collected from the national inpatient - (IPR), outpatient - (OPR) and cause of death registries. Cox proportional hazard models were used to analyze the longitudinal association between RHR and outcomes while adjusting for potential confounders. While we found no independent association between RHR and risk of IS or MI when comparing the highest with the lowest quintile of the RHR distribution, but a positive association persisted between RHR and incident HF (Hazard ratio (HR) = 1.39 [95% confidence interval (CI) = 1.29-1.49]) after adjustment for body mass index (BMI) and blood pressure (BP). In similarly adjusted models, an inverse association was found for AF while there were weaker associations with death from cardiovascular disease (CVD) and all causes (adjusted HR = 1.12 [CI = 1.04-1.21] and 1.20 [CI = 1.17-1.24]). After further adjustment for cardiorespiratory fitness (CRF), the associations persisted for HF (HR = 1.26 [1.17-1.35] for any diagnostic position and HR = 1.43 [1.28-1.60] for HF as a main diagnosis) and for all-cause death (HR 1.09 [1.05-1.12]) but not for CVD death.

CONCLUSION

Adolescent RHR is associated with future risk of HF and death, independently of BP, BMI and CRF, but not with CVD death, MI or IS, suggesting a causal pathway between elevated heart rate and myocardial dysfunction.

Elevated preoperative heart rate associated with increased risk of cardiopulmonary complications after resection for lung cancer

BACKGROUND

The study aimed to assess whether preoperative resting heart rate could be a risk factor for cardiopulmonary complications (CPCs) after lung cancer resection.

METHODS

Eligible consecutive patients who underwent resection surgery for non-small cell lung cancer (NSCLC) at Ningbo NO.2 Hospital between May, 2010 and July, 2015 were included. The demographic, clinical characteristics and laboratory parameters were compared in patients with or without CPCs within postoperative 30 days. The multivariate logistic regression analysis was used to analyze the association between CPCs and risk factors. Receiver operating characteristic (ROC) curve analysis was utilized for the predictive role of preoperative resting heart rate for CPCs.

RESULTS

One hundred eighty participants were enrolled into the final analysis and 42 of them had an established diagnosis of CPCs within postoperative 30 days. Elevated preoperative resting heart rate was an independent risk factor for postoperative CPCs (OR: 4.48, 95% CI: 1.17-18.42, P = 0.021) by the multivariate logistic regression analysis. ROC curve analysis indicated elevated resting heart rate as a predictor for CPCs with a cut-off value of 86 beats/min (AUC: 0.813, specificity: 80.95%, sensitivity: 72.46%, P < 0.001).

CONCLUSIONS

Elevated preoperative resting heart rate was associated with an increased risk of postoperative CPCs in patients after resection for lung cancer.

Relationship between resting heart rate and metabolic risk factors in breast cancer patients

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.