Resting Heart Rate and Long-term Outcomes Among the African American Population: Insights From the Jackson Heart Study.
Increased resting heart rate is associated with worse outcomes in studies of mostly white populations, but its significance is not well established in African Americans persons whose cardiac comorbidities and structural abnormalities differ.



To study the prognostic utility of heart rate in a community-based African American cohort in the Jackson Heart Study.



A total of 5261 participants in the Jackson Heart Study, a prospective, community-based study in Jackson, Mississippi, were evaluated. Baseline heart rate was assessed by quintiles and as a continuous variable. All participants with baseline heart rate documented by a 12-lead electrocardiogram without pacing or atrial fibrillation noted on their baseline Jackson Heart Study examination were included in the study. Follow-up began September 26, 2000, and was completed December 31, 2011. Data analysis was performed from July to October 2015.



Unadjusted and adjusted associations between heart rate and all-cause mortality and heart failure hospitalization using Cox proportional hazards regression models.



Of the 5261 individuals included in the analysis, 1921 (36.5%) were men; median (25th-75th percentile) age was 55.7 (45.4-64.8) years. Median (25th-75th percentile) baseline heart rate was 63 beats per minute (bpm) (57-71 bpm). The highest heart rate quintile (73-118 bpm) had higher rates of diabetes (398 [37.4%]; P < .001) and hypertension (735 [69.1%]; P < .001), higher body mass index (median [IQR], 32.4 [28.1-38.3]; P < .001), less physical activity (0 hours per week, 561 [52.8%]; P < .001), and lower β-blocker use (73 [6.9%]; P < .001) compared with lower quintiles. Caffeine intake (from 80.7 to 85.5 mg/d; P = .57) and left ventricular ejection fraction (from 62% to 62.3%; P = .01) were similar between groups. As a continuous variable, elevated heart rate was associated with increased mortality and heart failure hospitalizations, with adjusted hazard ratios for every 5-bpm increase of 1.14 (95% CI, 1.10-1.19) and 1.10 (95% CI, 1.05-1.16), respectively. Similar patterns were observed in comparisons between the highest and lowest quintiles.



Higher baseline heart rate was associated with increased mortality and heart failure hospitalizations among African American participants in the Jackson Heart Study. These findings are similar to those seen in white populations, but further study is needed to understand whether African American individuals benefit from interventions targeting heart rate reduction.
Duke Clinical Research Institute, Durham, North Carolina.
Kishan S
KS
Parikh
Duke Clinical Research Institute, Durham, North Carolina.
Melissa A
MA
Greiner
Department of Medicine, University of Mississippi School of Medicine, Jackson.
Takeki
T
Suzuki
Duke Clinical Research Institute, Durham, North Carolina3Department of Medicine, Duke University School of Medicine, Durham, North Carolina.
Adam D
AD
DeVore
Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson.
Chad
C
Blackshear
Department of Medicine, University of Mississippi School of Medicine, Jackson.
Joseph F
JF
Maher
Duke Clinical Research Institute, Durham, North Carolina3Department of Medicine, Duke University School of Medicine, Durham, North Carolina.
Lesley H
LH
Curtis
Duke Clinical Research Institute, Durham, North Carolina3Department of Medicine, Duke University School of Medicine, Durham, North Carolina.
Adrian F
AF
Hernandez
Duke Clinical Research Institute, Durham, North Carolina3Department of Medicine, Duke University School of Medicine, Durham, North Carolina.
Emily C
EC
O'Brien
Duke Clinical Research Institute, Durham, North Carolina3Department of Medicine, Duke University School of Medicine, Durham, North Carolina.
Robert J
RJ
Mentz
D001741:Black or African American; D004562:Electrocardiography; D015444:Exercise; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000208:ethnology / Q000503:physiopathology*; D006339:Heart Rate / Q000502:physiology*; D006760:Hospitalization / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D008922:Mississippi / Q000453:epidemiology; D009017:Morbidity / Q000639:trends; D011379:Prognosis; D011446:Prospective Studies; D012146:Rest / Q000502:physiology*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016277:Ventricular Function, Left / Q000502:physiology*
Eur Heart J. 2015 Mar 14;36(11):669-75
25368202
J Am Coll Cardiol. 2014 Apr 1;63(12):1182-9
24412444
J Am Heart Assoc. 2015 Apr 22;4(4):null
25904590
N Engl J Med. 2001 May 31;344(22):1659-67
11386264
Eur Heart J. 2005 May;26(10):967-74
15774493
Ethn Dis. 2005 Autumn;15(4 Suppl 6):S6-18-29
16317982
Am J Med Sci. 2004 Sep;328(3):131-44
15367870
Circulation. 2001 Sep 25;104(13):1477-82
11571239
JACC Heart Fail. 2013 Dec;1(6):488-96
24622000
Ethn Dis. 2005 Autumn;15(4 Suppl 6):S6-62-70
16317987
Am J Epidemiol. 2004 Apr 1;159(7):702-6
15033648
J Am Heart Assoc. 2014 May 08;3(3):e000668
24811610
Circulation. 2014 Jan 21;129(3):e28-e292
24352519
N Engl J Med. 2005 May 12;352(19):1951-8
15888695
CMAJ. 2016 Feb 16;188(3):E53-63
26598376
J Am Heart Assoc. 2015 Jan 14;4(1):e001364
25589535
IARC Sci Publ. 1987;(82):1-406
3329634
Heart Fail Clin. 2010 Jan;6(1):65-74
19945062
Lancet. 2010 Sep 11;376(9744):875-85
20801500
Ann Med. 2001 May;33(4):213-21
11405541
Ethn Dis. 2005 Autumn;15(4 Suppl 6):S6-1-3
16317981
Am Heart J. 1987 Jun;113(6):1489-94
3591616
J Intern Med. 2015 Jul;278(1):38-49
25431275
Nat Rev Cardiol. 2011 Jan;8(1):30-41
21060326
J Am Coll Cardiol. 2007 Aug 28;50(9):823-30
17719466
J Am Coll Cardiol. 1997 Mar 15;29(4):709-15
9091514
Eur J Heart Fail. 2010 Mar;12(3):232-8
20097681
Am J Med. 2015 Mar;128(3):219-28
25447617
J Card Fail. 1999 Sep;5(3):178-87
10496190
N Engl J Med. 2001 May 3;344(18):1351-7
11333991
Lancet. 2010 Sep 11;376(9744):886-94
20801495
Int J Cardiol. 2008 Jun 6;126(3):302-12
18068835