title: Long-term cardiovascular risks associated with an elevated heart rate: the Framingham Heart Study.
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.
  
  
  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.
authors.affiliation: Framingham Heart Study of the National Heart, Lung and Blood Institute, Boston University School of Medicine, Framingham, MA.
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Ho
authors.forename: Martin G
authors.initials: MG
authors.lastname: Larson
authors.forename: Anahita
authors.initials: A
authors.lastname: Ghorbani
authors.forename: Susan
authors.initials: S
authors.lastname: Cheng
authors.forename: Erin E
authors.initials: EE
authors.lastname: Coglianese
authors.forename: Ramachandran S
authors.initials: RS
authors.lastname: Vasan
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Wang
mesh_terms: D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology*; D003327:Coronary Disease / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006333:Heart Failure / Q000453:epidemiology / Q000209:etiology; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D016016:Proportional Hazards Models; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000209:etiology
keywords: cardiovascular disease; epidemiology; heart failure; risk factor