Long-term cardiovascular risks associated with an elevated heart rate: the Framingham Heart Study

Background-higher heart rate has been associated with an adverse prognosis,but most prior studies focused on individuals with known cardiovascular disease or examined a limited number of outcomes. we sought to examine the association of baseline heart rate with both fatal and nonfatal outcomes during 2 decades of follow-up. methods and results-our study included 4058 framingham heart study participants (mean age 55 years,56% women). cox models were performed with multivariable adjustment for clinical risk factors and physical activity. a total of 708 participants developed incident cardiovascular disease (303 heart failure,343 coronary heart disease,and 216 stroke events),48 received a permanent pacemaker,and 1186 died. baseline heart rate was associated with incident cardiovascular disease (hazard ratio [hr] 1.15 per 1 sd [11 bpm] increase in heart rate,95% ci 1.07 to 1.24,p=0.0002),particularly heart failure (hr 1.32,95% ci 1.18 to 1.48,p < 0.0001). higher heart rate was also associated with higher all-cause (hr 1.17,95% ci 1.11 to 1.24,p < 0.0001) and cardiovascular mortality (hr 1.18,95% ci 1.04 to 1.33,p=0.01). spline analyses did not suggest a lower threshold beyond which the benefit of a lower heart rate abated or increased. in contrast,individuals with a higher heart rate had a lower risk of requiring permanent pacemaker placement (hr 0.55,95% ci 0.38 to 0.79,p=0.001). conclusions-individuals with a higher heart rate are at elevated long-term risk for cardiovascular events,in particular,heart failure,and all-cause death. on the other hand,a higher heart rate is associated with a lower risk of future permanent pacemaker implantation. © 2014 the authors.