Association of Asymptomatic Bradycardia With Incident Cardiovascular Disease and Mortality: The Multi-Ethnic Study of Atherosclerosis (MESA)
Open accessAbstract
IMPORTANCE: Bradycardia has been associated with lower cardiovascular disease (CVD) risk in selected populations. There is a paucity of information available about heart rate (HR) less than 50 beats per minute (bpm) among middle-aged or older adults. OBJECTIVE: To determine whether asymptomatic bradycardia was associated with a lower cardiovascular risk profile, less subclinical atherosclerosis, and decreased incident CVD and mortality. DESIGN, SETTING, AND PARTICIPANTS: This retrospective analysis includes 6733 participants of the Multi-Ethnic Study of Atherosclerosis, which recruited men and women free of clinical cardiovascular disease ages 45 to 84 years from 2000 to 2002 and followed them over 10 years for incident CVD events and mortality. The HR was measured by baseline electrocardiogram. The analysis was performed in June 2014. MAIN OUTCOMES AND MEASURES: The association between HR categories with CVD events and all-cause mortality were examined using Cox proportional hazards models adjusted for potential confounders and mediators. RESULTS: The 6733 participants had a mean (SD) age of 62 (10.2) years; 47% were male. The mean (SD) HR was 63 (9.5) bpm among the 5831 participants not taking an HR-modifying drug; 5.3% had an HR lower than 50 bpm. Preliminary results revealed significant interaction for HR categories according to use of HR-modifying drugs for mortality (P = .002); thus, all further analyses were stratified. An HR of less than 50 bpm was not associated with incident CVD in either subgroup (participants taking or not taking HR-modifying drugs). Among participants not taking HR-modifying drugs, the fully adjusted mortality risk was not different for an HR less than 50 bpm (hazard ratio, 0.71 [95% CI, 0.41-1.09]; P = .12) and increased among those with an HR greater than 80 bpm (hazard ratio, 1.49 [95% CI, 1.08-2.05]; P = .01) (reference HR, 60-69 bpm). Among the 902 participants taking HR-modifying drugs there was an elevated mortality risk associated with an HR less than 50 bpm (hazard ratio, 2.42 [95% CI, 1.39-4.20]; P = .002) and with an HR greater than 80 bpm (hazard ratio, 3.55 [95% CI, 1.65-7.65]; P = .001) (reference HR, 60-69 bpm). CONCLUSIONS AND RELEVANCE: In a contemporary, community-based cohort, bradycardia was generally not associated with incident CVD or mortality except for a potential adverse association between bradycardia among those taking HR-modifying drugs.
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After multivariable risk adjustment, there was no increased risk for incident cardiovascular disease or mortality over a 10 year follow up period in MESA patients with heart rate <50 bpm.
“After multivariable risk adjustment, there was no increased risk for incident cardiovascular disease or mortality over a 10 year follow up period [9] .”
From Evaluating and managing bradycardia (2020) · cites this paper as [9]
The Results report a median follow-up of 10.1 years and no significant increase in adjusted incident CVD risk for participants with heart rates below 50 bpm. The Discussion reports no excess mortality in that heart-rate group among participants not taking heart-rate-modifying drugs, but significantly higher mortality among those taking them. The claim omits that important qualification. (LLM, conf=0.91)
Experimental — accuracy not yet measuredIn the MESA study, over 300 patients with a heart rate less than 50 bpm who were not on any heart rate-lowering medication were noted.
“The Multi-ethnic Study of Atherosclerosis (MESA), a longitudinal study of men and women aged 45-84 years old, noted over 300 patients with a heart rate less than 50 bpm who were not on any heart rate-lowering medication.”
From Evaluating and managing bradycardia (2020) · cites this paper as [9]
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- Authors
- Dharod, A., Soliman, E. Z., Dawood, F., Chen, H., Shea, S., Nazarian, S., Bertoni, A. G., & for the MESA Investigators
- Affiliations
- Wake Forest University Health Sciences (US)
- Columbia University Irving Medical Center (US)
- Johns Hopkins University (US)
- Corresponding author
- Dharod, Ajay
- Venue
- JAMA Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2016-02-01
- Volume
- 176
- Issue
- 2
- Pages
- 219
- ISSN
- 2168-6106 (ISSN-L)
- OpenAlex
- W2273402626
- Cited by
- 45
- References
- 29
- Citations by year
- 2026: 3 · 2025: 1 · 2024: 16 · 2023: 2 · 2022: 5 · 2021: 2 · 2020: 3 · 2019: 4 · 2018: 5 · 2016: 4
- FWCI
- 3.57
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (n01hc95164-17-0-1, n01hc95165-34-0-1, n01hc95161-24-0-1, n01hc095169-003, n01hc95166-21-0-1, n01hc95168-27-0-1, n01hc95160-18-0-1, n01hc095167-000, UL1TR001079, n01hc95163-22-0-1, n01hc95159-40-0-1, UL1TR000040)
- National Heart, Lung, and Blood Institute (N01 HC-95159, N01-HC-95160, N01 HC-95168, N01 HC95167, (N01-HC-95163, N01 HC-95161, N01 HC95165, N01HC95164, N01‐HC‐95166, N01 HC95169)
- National Center for Research Resources
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart rate and cardiovascular health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Keywords
- heart rate, cardiovascular disease incidence, all-cause mortality, subclinical atherosclerosis, carotid intima-media thickness, carotid plaque, middle-aged and older adults, Multi-Ethnic Study of Atherosclerosis, cardiovascular risk, atrial fibrillation, atrial flutter
- MeSH terms
- Aged, Aged, 80 and over, Bradycardia, Ethnicity, Female, Humans, Male, Middle Aged, Mortality, Retrospective Studies, Risk Factors, United States, Incidence, Atherosclerosis, Asymptomatic Diseases
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