title: Resting heart rate and all-cause and cardiovascular mortality in the general population: a meta-analysis.
abstract: BACKGROUND
  Data on resting heart rate and risk of all-cause and cardiovascular mortality are inconsistent; the magnitude of associations between resting heart rate and risk of all-cause and cardiovascular mortality varies across studies. We performed a meta-analysis of prospective cohort studies to quantitatively evaluate the associations in the general population.
  
  
  METHODS
  We searched PubMed, Embase and MEDLINE from inception to Jan. 1, 2015. We used a random-effects model to combine study-specific relative risks and 95% confidence intervals (CIs). We used restricted cubic spline functions to assess the dose-response relation.
  
  
  RESULTS
  A total of 46 studies were included in the meta-analysis, involving 1 246 203 patients and 78 349 deaths for all-cause mortality, and 848 320 patients and 25 800 deaths for cardiovascular mortality. The relative risk with 10 beats/min increment of resting heart rate was 1.09 (95% CI 1.07-1.12) for all-cause mortality and 1.08 (95% CI 1.06-1.10) for cardiovascular mortality. Compared with the lowest category, patients with a resting heart rate of 60-80 beats/min had a relative risk of 1.12 (95% CI 1.07-1.17) for all-cause mortality and 1.08 (95% CI 0.99-1.17) for cardiovascular mortality, and those with a resting heart rate of greater than 80 beats/min had a relative risk of 1.45 (95% CI 1.34-1.57) for all-cause mortality and 1.33 (95% CI 1.19-1.47) for cardiovascular mortality. Overall, the results did not differ after adjustment for traditional risk factors for cardiovascular disease. Compared with 45 beats/min, the risk of all-cause mortality increased significantly with increasing resting heart rate in a linear relation, but a significantly increased risk of cardiovascular mortality was observed at 90 beats/min. Substantial heterogeneity and publication bias were detected.
  
  
  CONCLUSIONS
  Higher resting heart rate was independently associated with increased risks of all-cause and cardiovascular mortality. This indicates that resting heart rate is a predictor of all-cause and cardiovascular mortality in the general population.
authors.affiliation: Departments of Epidemiology and Health Statistics (Zhang, Shen), and Clinical Medicine (Qi), Medical College of Qingdao University, Shandong, China zhangdf1961@126.com.
authors.forename: Dongfeng
authors.initials: D
authors.lastname: Zhang
authors.affiliation: Departments of Epidemiology and Health Statistics (Zhang, Shen), and Clinical Medicine (Qi), Medical College of Qingdao University, Shandong, China.
authors.forename: Xiaoli
authors.initials: X
authors.lastname: Shen
authors.affiliation: Departments of Epidemiology and Health Statistics (Zhang, Shen), and Clinical Medicine (Qi), Medical College of Qingdao University, Shandong, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Qi
mesh_terms: D002318:Cardiovascular Diseases / Q000401:mortality* / Q000503:physiopathology; D002423:Cause of Death; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D009026:Mortality; D012307:Risk Factors