title: Association between resting heart rate and coronary artery disease, stroke, sudden death and noncardiovascular diseases: a meta-analysis.
abstract: BACKGROUND
  Resting heart rate is linked to risk of coronary artery disease, stroke, sudden death and noncardiovascular diseases. We conducted a meta-analysis to assess these associations in general populations and in populations of patients with hypertension or diabetes mellitus.
  
  
  METHODS
  We searched PubMed, Embase and MEDLINE from inception to Mar. 5, 2016. We used a random-effects model to combine study-specific relative risks (RRs). We used restricted cubic splines to assess the dose-response relation.
  
  
  RESULTS
  We included 45 nonrandomized prospective cohort studies in the meta-analysis. The multivariable adjusted RR with an increment of 10 beats/min in resting heart rate was 1.12 (95% confidence interval [CI] 1.09-1.14) for coronary artery disease, 1.05 (95% CI 1.01-1.08) for stroke, 1.12 (95% CI 1.02-1.24) for sudden death, 1.16 (95% CI 1.12-1.21) for noncardiovascular diseases, 1.09 (95% CI 1.06-1.12) for all types of cancer and 1.25 (95% CI 1.17-1.34) for noncardiovascular diseases excluding cancer. All of these relations were linear. In an analysis by category of resting heart rate (< 60 [reference], 60-70, 70-80 and > 80 beats/min), the RRs were 0.99 (95% CI 0.93-1.04), 1.08 (95% CI 1.01-1.16) and 1.30 (95% CI 1.19-1.43), respectively, for coronary artery disease; 1.08 (95% CI 0.98-1.19), 1.11 (95% CI 0.98-1.25) and 1.08 (95% CI 0.93-1.25), respectively, for stroke; and 1.17 (95% CI 0.94-1.46), 1.31 (95% CI 1.12-1.54) and 1.57 (95% CI 1.39-1.77), respectively, for noncardiovascular diseases. After excluding studies involving patients with hypertension or diabetes, we obtained similar results for coronary artery disease, stroke and noncardiovascular diseases, but found no association with sudden death.
  
  
  CONCLUSIONS
  Resting heart rate was an independent predictor of coronary artery disease, stroke, sudden death and noncardiovascular diseases over all of the studies combined. When the analysis included only studies concerning general populations, resting heart rate was not associated with sudden death.
authors.affiliation: Department of Epidemiology and Health Statistics, Medical College of Qingdao University, Shandong, Qingdao, China zhangdf1961@126.com.
authors.forename: Dongfeng
authors.initials: D
authors.lastname: Zhang
authors.affiliation: Department of Epidemiology and Health Statistics, Medical College of Qingdao University, Shandong, Qingdao, China.
authors.forename: Weijing
authors.initials: W
authors.lastname: Wang
authors.affiliation: Department of Epidemiology and Health Statistics, Medical College of Qingdao University, Shandong, Qingdao, China.
authors.forename: Fang
authors.initials: F
authors.lastname: Li
mesh_terms: D002318:Cardiovascular Diseases / Q000453:epidemiology; D002423:Cause of Death; D003324:Coronary Artery Disease / Q000453:epidemiology*; D003645:Death, Sudden; D006339:Heart Rate; D006801:Humans; D015999:Multivariate Analysis; D012044:Regression Analysis; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology*