Resting heart rate and the risk of cardiovascular disease, total cancer, and all-cause mortality - A systematic review and dose-response meta-analysis of prospective studies.
Level 3 - non-randomized controlled study
Systematic review and meta-analysis of prospective observational cohort studies
PubMed 28552551 · doi:10.1016/j.numecd.2017.04.004
What was done
Authors conducted a systematic review and dose-response meta-analysis of prospective studies from PubMed and Embase up to March 29, 2017. They assessed the association between resting heart rate and the risk of coronary heart disease, sudden cardiac death, heart failure, atrial fibrillation, stroke, total cardiovascular disease, total cancer, and all-cause mortality using random-effects models.
What was found
Across 87 prospective studies, each 10 beats per minute increase in resting heart rate was associated with: - Coronary heart disease: RR 1.07 (95% CI: 1.05–1.10, I² = 61.9%, n = 31) - Sudden cardiac death: RR 1.09 (95% CI: 1.00–1.18, I² = 62.3%, n = 5) - Heart failure: RR 1.18 (95% CI: 1.10–1.27, I² = 74.5%, n = 8) - Atrial fibrillation: RR 0.97 (95% CI: 0.92–1.02, I² = 91.4%, n = 9; J-shaped association) - Total stroke: RR 1.06 (95% CI: 1.02–1.10, I² = 59.5%, n = 16) - Cardiovascular disease: RR 1.15 (95% CI: 1.11–1.18, I² = 84.3%, n = 35) - Total cancer: RR 1.14 (95% CI: 1.06–1.23, I² = 90.2%, n = 12) - All-cause mortality: RR 1.17 (95% CI: 1.14–1.19, I² = 94.0%, n = 48) A positive dose-response relationship was reported for all outcomes except atrial fibrillation.
Why it matters
This study provides comprehensive meta-analytic evidence that elevated resting heart rate is an independent predictor of major cardiovascular events, cancer incidence, and premature mortality.
Limits
The included studies were observational, which precludes establishing causality and leaves potential for residual confounding from cardiorespiratory fitness or subclinical disease. Statistical heterogeneity was high across nearly all endpoints (I² up to 94.0%), and the total participant count across studies is not stated in the abstract.