Resting heart rate as a low tech predictor of coronary events in women: prospective cohort study

Judith Hsia, Joseph C Larson, Judith K Ockene, Gloria E Sarto, Matthew A Allison, Susan L Hendrix, Jennifer G Robinson, Andrea Z LaCroix, JoAnn E Manson, Women's Health Initiative Research Group, Judith Hsia, Joseph C Larson, Judith K Ockene, Gloria E Sarto, Matthew A Allison, Susan L Hendrix, Jennifer G Robinson, Andrea Z LaCroix, JoAnn E Manson, Women's Health Initiative Research Group

Abstract

Objective: To evaluate resting heart rate as an independent predictor of cardiovascular risk in women.

Design: Prospective cohort study.

Setting: The Women's Health Initiative was undertaken at 40 research clinics in the United States.

Participants: 129 135 postmenopausal women.

Main outcome measure: Clinical cardiovascular events.

Results: During a mean of 7.8 (SD 1.6) years of follow up, 2281 women were identified with myocardial infarction or coronary death and 1877 with stroke. We evaluated associations between resting heart rate and cardiovascular events in Cox regression models adjusted for multiple covariates. Higher resting heart rate was independently associated with coronary events (hazard ratio 1.26, 95% confidence interval 1.11 to 1.42 for highest [>76 beats per minute] v lowest quintile [<or=62 beats per minute]; P=0.001), but not with stroke. The relation between heart rate and coronary events did not differ between white women and women from other ethnic groups (P for interaction=0.45) or between women with and without diabetes (P for interaction=0.31), but it was stronger in women aged 50-64 at baseline than in those aged 65-79 (P for interaction=0.009).

Conclusion: Resting heart rate, a low tech and inexpensive measure of autonomic tone, independently predicts myocardial infarction or coronary death, but not stroke, in women.

Trial registration: ClinicalTrials.gov NCT00000611.

Conflict of interest statement

Competing interests: None declared.

References

    1. Thayer JF, Lane RD. The role of vagal function in the risk for cardiovascular disease and mortality. Biol Psychol 2007;74:224-42.
    1. Kannel WB, Kannel C, Paffenbarger RS Jr, Cupples LA. Heart rate and cardiovascular mortality: the Framingham study. Am Heart J 1987;113:1489-94.
    1. Palatini P, Julius S. Heart rate and the cardiovascular risk. J Hypertens 1997;15:3-17.
    1. King DE, Everett CJ, Mainous AG 3rd, Liszka HA. Long-term prognostic value of resting heart rate in subjects with prehypertension. Am J Hypertens 2006;19:796-800.
    1. Palatini P. Need for a revision of the normal limits of resting heart rate. Hypertension 1999;33:622-5.
    1. Kannel WB, Wilson P, Blair SN. Epidemiologic assessment of the role of physical activity and fitness in development of cardiovascular disease. Am Heart J 1985;109:876-85.
    1. Goldberg RJ, Larson M, Levy D. Factors associated with survival to 75 years of age in middle-aged men and women. The Framingham study. Arch Intern Med 1996;156:505-9.
    1. Greenland P, Daviglus ML, Dyer AR, Liu K, Huang CF, Goldberger JJ et al. Resting heart rate is a risk factor for cardiovascular and noncardiovascular mortality. Am J Epidemiol 1999;149:853-62.
    1. Gillum RF, Makue DM, Feldman JJ. Pulse rate, coronary heart disease, and death: the NHANES I epidemiologic follow-up study. Am Heart J 1991;121:172-7.
    1. Bleil ME, Gianaros PJ, Jennings JR, Flory JD, Manuck SB. Trait negative affect: toward an integrated model of understanding psychologic risk for impairment in cardiac autonomic function. Psychosom Med 2008;70:328-37.
    1. Pizzi C, Manzoli L, Mancini S, Costa GM. Analysis of potential predictors of depression among coronary heart disease risk factors including heart rate variability, markers of inflammation, and endothelial function. Eur Heart J 2008;29:1110-7.
    1. Todaro JF, Shen BJ, Niaura R, Spiro A 3rd, Ward KD. Effect of negative emotions on frequency of coronary heart disease (The Normative Aging Study). Am J Cardiol 2003;92:901-6.
    1. The Women’s Health Initiative Study Group. Design of the Women’s Health Initiative Clinical Trial and Observational Study. Control Clin Trials 1998;19:61-109.
    1. Ritenbaugh C, Patterson RE, Chlebowski RT, Caan B, Fels-Tinker L, Howard B, et al. The Women’s Health Initiative Dietary Modification Trial: overview and baseline characteristics of participants. Ann Epidemiol 2003;13:S87-97.
    1. Stefanick ML, Cochrane BB, Hsia J, Barad DH, Liu JH, Johnson SR. The Women’s Health Initiative postmenopausal hormone trials: overview and baseline characteristics of participants. Ann Epidemiol 2003;13:S78-86.
    1. Langer RD, White E, Lewis CE, Kotchen JM, Hendrix SL, Trevisan M. The Women’s Health Initiative observational study: baseline characteristics of participants and reliability of baseline measures. Ann Epidemiol 2003;13:S107-21.
    1. Hsia J, Wu L, Allen C, Oberman A, Lawson WE, Torrens J, et al. Physical activity and diabetes risk in postmenopausal women. Am J Prev Med 2005;28:19-25.
    1. Wassertheil-Smoller S, Shumaker S, Ockene J, Talavera GA, Greenland P, Cochrane B, et al. Depression and cardiovascular sequelae in postmenopausal women. The Women’s Health Initiative. Arch Intern Med 2004;164:289-98.
    1. Curb JD, McTiernan A, Heckbert SR, Kooperberg C, Stanford J, Nevitt M, et al. Outcomes ascertainment and adjudication methods in the Women’s Health Initiative. Ann Epidemiol 2003;13:S122-8.
    1. Hendrix SL, Wassertheil-Smoller S, Johnson KC, Howard BV, Kooperberg C, Rossouw JE, et al. Effects of conjugated equine estrogen on stroke in the Women’s Health Initiative. Circulation 2006;113:2425-34.
    1. Kubzansky LD, Cole Sr, Kawachi I, Vokonas P, Sparrow D. Shared and unique contributions of anger, anxiety and depression to coronary heart disease: a prospective study in the normative aging study. Ann Behav Med 2006;31:21-9.
    1. Tully PJ, Baker RA, Knight JL. Anxiety and depression as risk factors for mortality after coronary artery bypass surgery. J Psychosom Res 2008;64:285-90.
    1. Ohira T, Roux AV, Prineas RJ, Kzilbash MA, Carnethon MR, Folsom AR. Associations of psychosocial factors with heart rate and its short-term variability: multi-ethnic study of atherosclerosis. Psychosom Med 2008;70:141-6.
    1. Kim CK, McGorray SP, Bartholomew BA, Marsh M, Dicken T, Wassertheil-Smoller S, et al. Depressive symptoms and heart rate variability in postmenopausal women. Arch Intern Med 2005;165:1239-44.
    1. Wassertheil-Smoller S, Hendrix SL, Limacher M, Heiss G, Kooperberg C, Baird A, et al. Effect of estrogen plus progestin on stroke in postmenopausal women: the Women’s Health Initiative. JAMA 2003;289:2673-84.
    1. Manson JE, Hsia J, Johnson KC, Rossouw JE, Assaf AR, Lasser NL, et al. Estrogen plus progestin and risk of coronary heart disease. N Engl J Med 2003;349:523-34.
    1. Prentice RL, Langer R, Stefanick ML, Howard BV, Pettinger M, Anderson G, et al. Combined postmenopausal hormone therapy and cardiovascular disease: toward resolving the discrepancy between observational studies and the Women’s Health Initiative Clinical Trial. Am J Epidemiol 2005;162:1-11.
    1. Grodstein F, Clarkson TB, Manson JE. Understanding the divergent data on postmenopausal hormone therapy. N Engl J Med 2003;348:645-50.

Source: PubMed

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