title: Resting heart rate and risk of incident heart failure: three prospective cohort studies and a systematic meta-analysis.
abstract: BACKGROUND
  The relationship between resting heart rate (RHR) and incident heart failure (HF) has been questioned.
  
  
  RESULTS
  RHR was assessed at baseline in 7073 participants in 3 prospective cohorts (Cardiovascular Health Study, Health ABC study and Kuopio Ischemic Heart Disease Study) that recorded 1189 incident HF outcomes during 92 702 person-years of follow-up. Mean age of participants was 67 (9.9) years and mean RHR was 64.6 (11.1) bpm. Baseline RHR correlated (P<0.001) positively with body mass index (r=0.10), fasting glucose (r=0.18), and C-reactive protein (r=0.20); and inversely with serum creatinine (r=-0.05) and albumin (r=-0.05). Baseline RHR was non-linearly associated with HF risk. The age and sex-adjusted hazard ratio for HF comparing the top (>72 bpm) versus the bottom (<57 bpm) quartile of baseline RHR was 1.48 (95% confidence interval [CI] 1.26 to 1.74) and was modestly attenuated (1.30, 95% CI 1.10 to 1.53) with further adjustment for body mass index, history of diabetes, hypertension, smoking status, serum creatinine, and left ventricular hypertrophy. These findings remained consistent in analyses accounting for incident coronary heart disease, excluding individuals with prior cardiovascular events, or those taking beta-blockers; and in subgroups defined by several individual participant characteristics. In a pooled random effects meta-analysis of 7 population-based studies (43 051 participants and 3476 HF events), the overall hazard ratio comparing top versus bottom fourth of RHR was 1.40 (95% CI: 1.19 to 1.64).
  
  
  CONCLUSIONS
  There is a non-linear association between RHR and incident HF. Further research is needed to understand the physiologic foundations of this association.
authors.affiliation: Department of Medicine, Emory University, Atlanta, GA (H.K., A.P.K., V.V.G.).
authors.forename: Hassan
authors.initials: H
authors.lastname: Khan
authors.affiliation: Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK (S.K.).
authors.forename: Setor
authors.initials: S
authors.lastname: Kunutsor
authors.affiliation: Department of Medicine, Emory University, Atlanta, GA (H.K., A.P.K., V.V.G.).
authors.forename: Andreas P
authors.initials: AP
authors.lastname: Kalogeropoulos
authors.affiliation: Department of Medicine, Emory University, Atlanta, GA (H.K., A.P.K., V.V.G.).
authors.forename: Vasiliki V
authors.initials: VV
authors.lastname: Georgiopoulou
authors.affiliation: Department of Epidemiology and Medicine, University of Pittsburgh, PA (A.B.N.).
authors.forename: Anne B
authors.initials: AB
authors.lastname: Newman
authors.affiliation: Intramural Research Program, Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Bethesda, MD (T.B.H.).
authors.forename: Tamara B
authors.initials: TB
authors.lastname: Harris
authors.affiliation: Departments of Medicine and Epidemiology & Biostatistics, University of California, San Francisco, CA (K.B.D.).
authors.forename: Kirsten
authors.initials: K
authors.lastname: Bibbins-Domingo
authors.affiliation: Institute of Public Health, School and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland (J.K., J.A.L.).
authors.forename: Jussi
authors.initials: J
authors.lastname: Kauhanen
authors.affiliation: Center for Cardiovascular Innovation, Northwestern Feinberg School of Medicine, Chicago, IL (M.G.).
authors.forename: Mihai
authors.initials: M
authors.lastname: Gheorghiade
authors.affiliation: Cardiology Division, University of California Los Angeles, Los Angeles, CA (G.C.F.).
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.affiliation: Section of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston Salem, NC (S.B.K.).
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Kritchevsky
authors.affiliation: Institute of Public Health, School and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland (J.K., J.A.L.).
authors.forename: Jari A
authors.initials: JA
authors.lastname: Laukkanen
authors.affiliation: Division of Cardiology, Health Sciences Center, Stony Brook University, SUNY at Stony Brook, NY (J.B.).
authors.forename: Javed
authors.initials: J
authors.lastname: Butler
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology*; D015331:Cohort Studies; D005260:Female; D006333:Heart Failure / Q000453:epidemiology* / Q000503:physiopathology*; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D015994:Incidence; D007564:Japan; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012146:Rest; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D015996:Survival Rate
keywords: heart failure; heart rate; risk factor