title: Resting heart rate is an independent predictor of all-cause mortality in the middle aged general population.
abstract: BACKGROUND
  High resting heart rate (RHR) predicts cardiovascular outcomes in patients with vascular disease and heart failure. We evaluated the prognostic value of RHR in a large contemporary population-based, prospective cohort of individuals without known coronary artery disease.
  
  
  RESULTS
  Resting heart rate (RHR) was determined in 4091 individuals (mean age 59.2 ± 7.7; 53 % women) from the Heinz Nixdorf RECALL study, of whom, 3348 were free of heart rate lowering medication. During 10.5 years of follow-up (median), 159 (3.9 %) individuals developed a coronary event and 398 (9.7 %) died of any cause. Persons without any event (n = 3603) had similar heart rates as persons with coronary events (69.5 ± 11 versus 69.9 ± 11 bpm, p = 0.51) but lower heart rates than persons who died (72.3 ± 13 bpm, p < 0.0001). In individuals without heart rate lowering medication, an increase in heart rate by 5 bpm was associated with an increased hazard ratio (HR) for all-cause mortality of 13 % in unadjusted analysis and also upon adjustment for traditional cardiovascular risk factors, including coronary artery calcification [full model: HR (95 % CI) 1.13 (1.07-1.20), p < 0.0001], but not for coronary events [HR 1.02 (0.94-1.11), p = 0.60]. In individuals without heart rate lowering medication, the HR (full model) for heart rate ≥70 versus <70 bpm with regard to all-cause mortality and coronary events was 1.68 (1.30-2.18), p < 0.0001, and 1.20 (0.82-1.77), p = 0.35. Analysis of the entire cohort revealed a continuous relationship of heart rate with all-cause mortality [HR for lowest to highest heart rate quartile 1.64 (1.22-2.22), p = 0.001, full model] but not with coronary events [HR 1.04 (0.65-1.66), p = 0.86].
  
  
  CONCLUSIONS
  In the general population without known coronary artery disease and heart rate lowering medication, elevated RHR is an independent risk marker for all-cause mortality but not for coronary events.
authors.affiliation: Clinic of Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, Saarland University Clinic, Homburg, Saar, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Custodis
authors.affiliation: Institute for Medical Informatics, Biometry and Epidemiology, University Clinic Essen, Essen, Germany.
authors.forename: Ulla
authors.initials: U
authors.lastname: Roggenbuck
authors.affiliation: Institute for Medical Informatics, Biometry and Epidemiology, University Clinic Essen, Essen, Germany.
authors.forename: Nils
authors.initials: N
authors.lastname: Lehmann
authors.affiliation: Institute for Medical Informatics, Biometry and Epidemiology, University Clinic Essen, Essen, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Moebus
authors.affiliation: Clinic of Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, Saarland University Clinic, Homburg, Saar, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Laufs
authors.affiliation: Clinic of Cardiology, West-German Heart and Vascular Center Essen, University Clinic Essen, Essen, Germany.
authors.forename: Amir-Abbas
authors.initials: AA
authors.lastname: Mahabadi
authors.affiliation: Institute for Pathophysiology, West-German Heart and Vascular Center Essen, University Clinic Essen, Essen, Germany.
authors.forename: Gerd
authors.initials: G
authors.lastname: Heusch
authors.affiliation: Institute of Clinical Chemistry and Laboratory Medicine, University Clinic Essen, Essen, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Mann
authors.affiliation: Institute for Medical Informatics, Biometry and Epidemiology, University Clinic Essen, Essen, Germany.
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Jöckel
authors.affiliation: Clinic of Cardiology, West-German Heart and Vascular Center Essen, University Clinic Essen, Essen, Germany.
authors.forename: Raimund
authors.initials: R
authors.lastname: Erbel
authors.affiliation: Clinic of Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, Saarland University Clinic, Homburg, Saar, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Böhm
authors.affiliation: Clinic of Cardiology, West-German Heart and Vascular Center Essen, University Clinic Essen, Essen, Germany. stefan.moehlenkamp@bethanienmoers.de.|Clinic of Cardiology and Intensive Care Medicine, Bethanien Hospital Moers, Bethanienstrasse 21, 47441, Moers, Germany. stefan.moehlenkamp@bethanienmoers.de.
authors.forename: Stefan
authors.initials: S
authors.lastname: Möhlenkamp
mesh_terms: D000367:Age Factors; D000368:Aged; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology*; D002423:Cause of Death; D005260:Female; D005858:Germany; D006339:Heart Rate; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
keywords: Coronary events; Mortality; Resting heart rate