Long-term cardiovascular risks associated with an elevated heart rate: The Framingham Heart Study

Jennifer E. Ho, Martin G. Larson, Anahita Ghorbani, Susan Cheng, Erin E. Coglianese, Ramachandran S. Vasan, Thomas J. Wang

Research output: Contribution to journalArticlepeer-review

66 Scopus citations

Abstract

Background-Higher heart rate has been associated with an adverse prognosis, but most prior studies focused on individuals with known cardiovascular disease or examined a limited number of outcomes. We sought to examine the association of baseline heart rate with both fatal and nonfatal outcomes during 2 decades of follow-up. Methods and Results-Our study included 4058 Framingham Heart Study participants (mean age 55 years, 56% women). Cox models were performed with multivariable adjustment for clinical risk factors and physical activity. A total of 708 participants developed incident cardiovascular disease (303 heart failure, 343 coronary heart disease, and 216 stroke events), 48 received a permanent pacemaker, and 1186 died. Baseline heart rate was associated with incident cardiovascular disease (hazard ratio [HR] 1.15 per 1 SD [11 bpm] increase in heart rate, 95% CI 1.07 to 1.24, P=0.0002), particularly heart failure (HR 1.32, 95% CI 1.18 to 1.48, P < 0.0001). Higher heart rate was also associated with higher all-cause (HR 1.17, 95% CI 1.11 to 1.24, P < 0.0001) and cardiovascular mortality (HR 1.18, 95% CI 1.04 to 1.33, P=0.01). Spline analyses did not suggest a lower threshold beyond which the benefit of a lower heart rate abated or increased. In contrast, individuals with a higher heart rate had a lower risk of requiring permanent pacemaker placement (HR 0.55, 95% CI 0.38 to 0.79, P=0.001). Conclusions-Individuals with a higher heart rate are at elevated long-term risk for cardiovascular events, in particular, heart failure, and all-cause death. On the other hand, a higher heart rate is associated with a lower risk of future permanent pacemaker implantation.

Original languageEnglish (US)
Article number000668
JournalJournal of the American Heart Association
Volume3
Issue number3
DOIs
StatePublished - 2014
Externally publishedYes

Keywords

  • Cardiovascular disease
  • Epidemiology
  • Heart failure
  • Risk factor

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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