Association between resting heart rate and coronary artery disease, stroke, sudden death and noncardiovascular diseases: a meta-analysis
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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. INTERPRETATION: 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.
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Pulse rate is an independent risk factor for cardiovascular outcomes and mortality.
“Furthermore, several studies, including the DCCT/EDIC, have established pulse rate as an independent risk factor for cardiovascular outcomes and mortality [23, 25–28].”
In healthy populations, a high resting heart rate is associated with an increased risk of coronary artery disease and all-cause death.
“In healthy populations, a high resting HR has been associated with an increased risk of coronary artery disease and all-cause death12 and is also well recognized as a predictor of adverse outcomes in patients with heart failure (HF)13.”
From Smart wearable devices in cardiovascular care: Where we are and how to move forward (2021) · cites this paper as [12]
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- Authors
- Zhang, D., Wang, W., & Li, F.
- Affiliations
- Qingdao University (CN)
- Venue
- Canadian Medical Association Journal
- Publisher
- CMA Joule Inc.
- Published
- 2016-08-22
- Volume
- 188
- Issue
- 15
- Pages
- E384-E392
- ISSN
- 0820-3946 (ISSN-L)
- 1488-2329
- PMC
- PMC5056889
- OpenAlex
- W2513254145
- Cited by
- 120
- References
- 63
- Citations by year
- 2026: 7 · 2025: 14 · 2024: 11 · 2023: 17 · 2022: 13 · 2021: 14 · 2020: 6 · 2019: 14 · 2018: 13 · 2017: 10 · 2016: 1
- FWCI
- 2.23
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Canadian Medical Association Journal (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- 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 › Cardiovascular Health and Risk Factors
- Keywords
- resting heart rate, coronary artery disease, stroke, sudden death, cancer risk, hypertension, diabetes mellitus, cardiovascular risk factors, dose-response relationship, cardiovascular mortality, all-cause mortality, cardiovascular risk stratification, cardiac rehabilitation, cardiovascular screening, cardiovascular education, cardiovascular health promotion
- MeSH terms
- Cardiovascular Diseases, Cause of Death, Coronary Artery Disease, Death, Sudden, Heart Rate, Humans, Regression Analysis, Risk Factors, Multivariate Analysis, Stroke
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