title: Resting heart rate as a tool for risk stratification in primary care: does it provide incremental prognostic information?
abstract: BACKGROUND
  Several selected population-based studies have emphasized the significance of resting heart rate as an independent cardiovascular risk factor. However, there are no data available for using resting heart rate as a cardiovascular risk predictor in contemporary primary care. Thus, the aim of our analysis was to examine the clinical value of the measurement of resting heart rate in a large, unselected population-based cohort of primary care subjects under the conditions of contemporary primary prevention.
  
  
  METHODS
  Prospective, population-based cohort study.
  
  
  METHODS
  We examined a subgroup of 5320 unselected primary care subjects free of coronary artery disease from the nationwide, longitudinal Diabetes Cardiovascular Risk Evaluation Targets and Essential Data for Commitment of Treatment (DETECT) cohort study, which was conducted from 2003 to 2008.
  
  
  RESULTS
  During the follow-up time of 5 years, 258 events were reported. Elevated resting heart rate was not associated with an increased risk for cardiovascular events (HR = 0.75, p = 0.394), cardiovascular mortality (HR = 0.71, p = 0.616) or major cardiovascular events (HR = 0.77, p = 0.376). By cross-sectional analysis, elevated heart rate clustered with markers of the metabolic syndrome, like increased blood pressure (systolic: OR = 5.54, p < 0.0001; diastolic: OR = 3.82, p < 0.0001), elevated fasting plasma glucose levels (OR = 8.84, p < 0.0001), hypertriglyceridaemia (OR = 22.16, p = 0.001), and obesity (body mass index OR = 0.89, p < 0.0001). Assessment of resting heart rate in clinical practice had minimal and non-significant additional prognostic value compared to established cardiovascular risk factors as judged by C statistics (C = 0.001, p = 0.979).
  
  
  CONCLUSIONS
  The measurement of resting heart rate in the daily routine of primary care does not provide incremental prognostic information for cardiovascular risk stratification.
authors: Department of Internal Medicine III, Cardiology, Goethe-University of Frankfurt, Theodor-Stern-Kai 7, Frankfurt/Main, Germany.
authors: David M
authors: DM
authors: Leistner
authors: Jens
authors: J
authors: Klotsche
authors: Sylvia
authors: S
authors: Palm
authors: Lars
authors: L
authors: Pieper
authors: Günter K
authors: GK
authors: Stalla
authors: Hendrik
authors: H
authors: Lehnert
authors: Sigmund
authors: S
authors: Silber
authors: Winfried
authors: W
authors: März
authors: Hans-Ulrich
authors: HU
authors: Wittchen
authors: Andreas M
authors: AM
authors: Zeiher
mesh_terms: D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications* / Q000503:physiopathology; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D011320:Primary Health Care; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D011795:Surveys and Questionnaires