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Adolescent health benefits of different physical activity (PA) intensities, especially of lower intensities, are debated due to challenges in accelerometer data processing and analyses. Using a new accelerometer data processing method and multivariate pattern analysis, this study investigated the association of PA intensities with indicators of cardiovascular and mental health. Adolescents (n = 1,235, mean age 13.6 years, 41% males) were examined for cardiovascular health: body mass index (BMI) z-score, waist circumference (WC), resting heart rate and blood pressure, white blood cell count (WBC), pulse wave velocity (PWV), and answered questionnaires assessing stress and psychosomatic symptoms. Sex, age, and socioeconomic status were confounders. Hip-worn accelerometer data were processed with 10 Hz frequency extended method and a spectrum of 22 PA intensity categories was analyzed for association with health using partial least squares regression. Total explained variances for BMI z-score, WC, resting heart rate, stress, and psychosomatic symptoms were higher (3.3%–8.7%) compared to diastolic blood pressure, WBC, and PWV (0.9%–1.4%). We found positive associations of high-end moderate PA and vigorous PA with cardiovascular and mental health indicators. More sedentary time and lower level of light PA were associated with higher BMI z-score, WC, resting heart rate, diastolic blood pressure, WBC, and PWV, but not with mental health indicators. Very vigorous PA was negatively associated with resting heart rate, stress, and psychosomatic symptoms. In adolescents, PA of varying intensities were generally found to be positively associated with better cardiovascular health, but only higher intensity PA was associated with better mental health. [ABSTRACT FROM AUTHOR]

To evaluate the consistency on the target heart rate for exercise determined by simple target heart rate (sTHR) based on resting heart rate (HRrest) and heart rate at anaerobic threshold (HRAT) in cardiopulmonary exercise test (CPET) for patients with chronic heart failure. This is a retrospective cohort study, in which CHF patients who underwent CPET in Tongji Hospital Cardiac Rehabilitation Center Affiliated to Tongji University from March 2007 to December 2018 were enrolled. The clinical data of the patients from the electronic medical record system, HRrest and HRAT measured by CPET were collected. Patients were further divided into subgroups according to gender, age (<60 years group and ≥ 60 years group), with or without beta-blocker therapy and subgroup of heart failure (heart failure with reduced, mid-range and preserved ejection fraction). The sTHR (HRrest plus 10, 15, 20, 25 and 30 bpm) and HRAT were all calculated in each patient. Paired t- test was used for the difference between the two methods, correlation analysis was shown by pearson analysis and intraclass correlation coefficient (ICC) was calculated for consistency test. A total of 547 CHF patients were enrolled, including 447 males (81.7%), aged 63 (56,69) years, with BMI of 25.2 (23.5,26.4) kg/m2 and LVEF of 45.0 (36.0, 52.0) %. The target heart rate determined by HRAT method was (93.59 ± 13.95) bpm, and its counterpart determined by HRrest plus 20 bpm (HRrest +20) was (93.16 ± 7.69) bpm. There was no significant difference between the two methods (P >0.05). However, it was statistically different between HRrest plus 10, 15, 25, 30 bpm and HRAT respectively (P <0.001). And HRrest +20 was positively correlated with HRAT (r = 0.418, P <0.001). Therefore, HRrest +20 below was regarded as sTHR. The ICC of the consistency test between sTHR and HRAT was 0.523,95%CI 0.435–0.596 (P < 0.001) in all patients (n = 547). In patients with beta-blocker therapy (n = 464), the ICC of sTHR and HRAT consistency test was 0.534,95%CI 0.441–0.612, P < 0.001; The ICC of the consistency test between sTHR and HRAT of patients without beta-blocker therapy (n = 83) was 0.407,95%CI 0.083–0.616, P < 0.05. In the sinus rhythm group (n = 466), the ICC of sTHR and HRAT consistency test was 0.527,95%CI 0.433–0.606, P < 0.001; The ICC of the consistency test between sTHR and HRAT of atrial fibrillation patients in group (n = 81) was 0.482,95%CI 0.195–0.667, P < 0.05.The ICC of the consistency test between sTHR and HRAT was 0.501,95%CI 0.338–0.623 (P < 0.001) in patients under 60 years old (n = 195); The ICC of the consistency test between sTHR and HRAT in patients ≥60 years old (n = 352) was 0.533,95%CI 0.424–0.621, P < 0.001. In the male group (n = 447), the ICC of sTHR and HRAT consistency test was 0.577,95%CI 0.491–0.649, P < 0.001; The ICC of the consistency test between sTHR and HRAT of female patients in group (n = 100) was 0.344,95%CI 0.025–0.559, P < 0.05. The ICC of sTHR and HRAT consistency test in HFrEF group (n = 170) was 0.395,95%CI 0.181–0.553, P < 0.01; The ICC values of the consistency test between sTHR and HRAT was 0.543, 95%CI 0.405–0.649 (P < 0.001) in patients with HFmrEF (n = 222); In HFpEF group (n = 155), the ICC of sTHR and HRAT consistency test was 0.620,95%CI 0.478–0.723, P < 0.001. The exercise target heart rate calculated by HRrest is consistent with that determined by HRAT in patients with CHF. For primary hospitals without CPET, exercise prescription equivalent to AT intensity for patients with CHF can be determined by HRrest. However, the target heart rate calculated by HRrest can't replace that determined by HRAT in this patient cohort completely. • In patients with CHF, the exercise target heart rate determined by HRrest plus 20 bpm is consistent with by AT. • It's feasible to develop exercise prescription equivalent to AT intensity for CHF patients by HRrest without CPET. • HRrest plus 20 bpm can be of clinical value in exercise therapy for CHF patients in primary hospitals. [ABSTRACT FROM AUTHOR]

Although resting heart rate (RHR) is associated with prevalence and incidence of diabetes, whether it is associated with undiagnosed diabetes is still unclear. We aimed to investigate whether the RHR is associated with the prevalence of undiagnosed diabetes in a large Korean national dataset. The Korean National Health and Nutrition Examination Survey data from 2008 to 2018 were used. After screening, 51,637 participants were included in this study. The odds ratios and 95% confidence intervals (CIs) for undiagnosed diabetes were calculated using multivariable-adjusted logistic regression analyses. Analyses showed that participants with a RHR of ≥90 bpm showed a 4.00- (95% CI: 2.77–5.77) and 3.21-times (95% CI: 2.01–5.14) higher prevalence of undiagnosed diabetes for men and women, respectively, than those with a RHR of <60 bpm. The linear dose-response analyses showed that each 10-bpm increment in RHR was associated with a 1.39- (95% CI: 1.32–1.48) and 1.28-times (95% CI: 1.19–1.37) higher prevalence of undiagnosed diabetes for men and women, respectively. In the stratified analyses, the positive association between RHR and the prevalence of undiagnosed diabetes was tended to be stronger among those who were younger (age: <40 years) and lean (BMI: <23 kg/m2). Elevated RHR was significantly associated with a higher prevalence of undiagnosed diabetes in Korean men and women, independent of demographic, lifestyle, and medical factors. Accordingly, the value of RHR as a clinical indicator and health marker, especially in reducing the prevalence of undiagnosed diabetes, is suggestible. [ABSTRACT FROM AUTHOR]

This study aimed to investigate associations of resting heart rate (RHR) and blood pressure (BP) with all-cause and cardiovascular disease (CVD) mortality. A retrospective cohort study. A total of 67,028 Chinese participants aged ≥60 years were included in the analysis. RHR, systolic blood pressure (SBP), and diastolic blood pressure (DBP) were evaluated according to quartiles ([41–69, 70–74, 75–79, 80–127 beats/min], [80–119, 120–129, 130–139, 140–238 mm Hg], and [40–70, 71–79, 80–84, 85–133 mm Hg]). Cox proportional hazard models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) of all-cause and CVD mortality with RHR, SBP, and DBP. Restricted cubic splines were used to evaluate the dose–response association. During the 361,975 person-year follow-up, 9326 deaths were recorded, of which 5039 deaths were due to CVD. The risk of all-cause mortality was increased by 25% with the quartiles four vs quartile one of RHR (HR [95% CI]:1.25 [1.17–1.33]), and CVD mortality was increased by 32% (HR [95% CI]: 1.32 [1.22–1.44]). Similar results were observed when comparing the quartiles four vs quartile one of SBP with the risk of all-cause and CVD mortality (HRs [95% CIs]: 1.14 [1.07, 1.22] and 1.23 [1.12. 1.34]) and DBP with the risk of all-cause and CVD mortality (HRs [95% CIs]: 1.17 [1.11. 1.24] and 1.36 [1.26. 1.47]). We found linear associations of RHR, SBP, and DBP with all-cause and CVD mortality (P non-linearity >0.05), except for the approximately J-shaped association between DBP and all-cause mortality (P non-linearity = 0.008). There was a significant interaction of RHR and SBP with all-cause and CVD mortality (P interaction <0.05). RHR and BP increased the risk of all-cause and CVD mortality, especially fast RHR combined with high SBP. [ABSTRACT FROM AUTHOR]

Objective: The study examined the association between resting heart rate (RHR) of early pregnancy and risk of gestational diabetes mellitus (GDM) in Chinese population.Methods: As retrospective study, medical data of 15,092 pregnant women gave birth in 2019 was collected and analyzed. The pregnant women's age, educational level, pre-pregnancy body weight, height, parity, family history of diabetes, lipid profile, blood pressure and RHR were recorded during 11 ∼ 13+6 weeks. Multivariate logistic regression analysis was used to estimate the association between maternal characteristics and RHR and GDM. And we further evaluated the predictive roll of RHR in different sub-groups defined by their body mass index (BMI), age, fasting plasma glucose (FPG), total cholesterol and triglyceride.Results: 2313 women (15.33%) were diagnosed as GDM according to 75 g OGTT. According to the quartile value of RHR, the subjects were divided into four groups. Risk of GDM increased significantly as RHR increased. In the fully adjusted model, ORs(95%CI) for the lowest vs highest quartiles of heart rate were 1(as reference), 1.14(0.97 ∼ 1.33), 1.25(1.05 ∼ 1.40), 1.41(1.21 ∼ 1.62), respectively. In the subgroup's analysis, we found the relationship between RHR and risk of GDM was evident in women with low and normal BMI; with normal fasting plasma; and normal serum lipid level.Conclusion: The current study shows early-pregnancy maternal RHR is associated with potential risk of developing GDM. [ABSTRACT FROM AUTHOR]

Resting heart rate (RHR) during hospitalization has been shown to be associated with adverse outcomes in patients with myocardial infarction (MI). This study aimed to evaluate the long-term prognostic effect of RHR during the stable phase after MI in post-MI patients. Patients who had prior or new-onset MI and RHR measurements during the stable period after MI between 2006 and 2018 in the community-based Kailuan Study were enrolled. RHR was divided into four groups based on quartiles. Cox regression analysis was used to analyze the association of RHR with primary composite outcome of all-cause death, hospitalization for heart failure (HF), stroke, and recurrent MI and its components. A total of 4447 post-MI patients were included. During a median follow-up of 7.5 years, 1813 patients (40.8%) developed primary outcomes. Compared to RHR ≤67 bpm, patients with 72 < RHR ≤80 bpm and RHR >80 bpm had increased risks of primary outcome, with adjusted hazard ratios (95% confidence intervals) of 1.23 (1.08–1.40) and 1.35 (1.18–1.55), respectively. The risk of primary outcome increased by 12% (1.07–1.17) for each 10-bpm increase in RHR. Similar results were observed in all-cause death and hospitalization for HF. Restricted cubic splines revealed a linear relationship between RHR and primary outcome, all-cause death, and hospitalization for HF (P for nonlinearity >0.05). RHR during the stable phase after MI was an independent predictor for primary outcome and all-cause death in post-MI patients, and RHR >72 bpm was associated with increased risk for primary outcome and all-cause death. • RHR measured during the stable phase after MI was independently associated with the primary outcome, all-cause death, and hospitalization for HF but not with recurrent MI and stroke in post-MI patients. • RHR >72 bpm was associated with an increased risk for the primary outcome and all-cause death in patients with MI. RHR reduction in patients with RHR >72 bpm needed to be studied in prospective trials to ascertain if it would reduce adverse outcomes in post-MI patients. [ABSTRACT FROM AUTHOR]

Background: High resting heart rate (RHR) occurs in parallel with type 2 diabetes (T2D) and metabolic disorders, implying shared etiology between them. However, it is unknown if they are causally related, and no study has been conducted to investigate the shared mechanisms underlying these associations.Objectives: The objective of this study was to understand the genetic basis of the association between resting heart rate and cardiometabolic disorders/T2D.Methods: This study examined the genetic correlation, causality, and shared genetics between RHR and T2D using LD Score regression, generalized summary data-based Mendelian randomization, and transcriptome wide association scan (TWAS) in UK Biobank data (n = 428,250) and summary-level data for T2D (74,124 cases and 824,006 control subjects) and 8 cardiometabolic traits (sample size ranges from 51,750 to 236,231).Results: Significant genetic correlation between RHR and T2D (rg = 0.22; 95% confidence interval: 0.18 to 0.26; p = 1.99 × 10-22), and 6 cardiometabolic traits (fasting insulin, fasting glucose, waist-hip ratio, triglycerides, high-density lipoprotein, and body mass index; rg range -0.12 to 0.24; all p < 0.05) were observed. RHR has significant estimated causal effect on T2D (odds ratio: 1.12 per 10-beats/min increment; p = 7.79 × 10-11) and weaker causal estimates from T2D to RHR (0.32 beats/min per doubling increment in T2D prevalence; p = 6.14 × 10-54). Sensitivity analysis by controlling for the included cardiometabolic traits did not modify the relationship between RHR and T2D. TWAS found locus chr2q23.3 (rs1260326) was highly pleiotropic among RHR, cardiometabolic traits, and T2D, and identified 7 genes (SMARCAD1, RP11-53O19.3, CTC-498M16.4, PDE8B, AKTIP, KDM4B, and TSHZ3) that were statistically independent and shared between RHR and T2D in tissues from the nervous and cardiovascular systems. These shared genes suggested the involvement of epigenetic regulation of energy and glucose metabolism, and AKT activation-related telomere dysfunction and vascular endothelial aging in the shared etiologies between RHR and T2D. Finally, FADS1 was found to be shared among RHR, fasting glucose, high-density lipoprotein, and triglycerides.Conclusions: These findings provide evidence of significant genetic correlations and causation between RHR and T2D/cardiometabolic traits, advance our understanding of RHR, and provide insight into shared etiology for high RHR and T2D. [ABSTRACT FROM AUTHOR]

Abstract Despite consistent findings associating autonomic activity, such as resting heart rate, with antisocial behavior, the research connecting autonomic variables to related phenotypes, such as psychopathy and sensation seeking, has been mixed. The existing research in this area has been limited by underpowered samples, focused predominantly on incarcerated males, frequently dichotomized samples into "psychopaths" and controls, and failed to consider potential gender differences. The current study sought to address some of these limitations using a relatively large undergraduate sample (N = 453), four measures of autonomic activity (e.g., resting heart rate, resting skin conductance, heart rate reactivity, and skin conductance reactivity), a sensation seeking scale, and two measures of psychopathic traits. In order to thoroughly assess possible gender differences, the analyses were conducted for males and females separately. Few significant associations were found between the autonomic and psychological variables, and most became insignificant after controlling for age and race and correcting for multiple comparisons. The current study offers little support for an association between autonomic activity and sensation seeking or psychopathic traits. [ABSTRACT FROM AUTHOR]

Background and Aims: Elevated resting heart rate (RHR) is associated with risk of type 2 diabetes mellitus (T2DM). However, the association of change in RHR (ΔRHR) and incident T2DM is not fully elucidated. We aimed to assess the dose-response association between 6-year ΔRHR and T2DM.Methods and Results: A total of 12155 non-T2DM participants ≥18 years old were enrolled during 2007-2008 and followed up during 2013-2014. ΔRHR was calculated by subtracting the baseline RHR from the RHR value at 6-year follow-up. Age-, sex-, and RHR-specific relative risks (RRs) and 95% confidence intervals (CIs) for the effect of ΔRHR on incident T2DM were calculated by using modified Poisson regression models. As compared with ΔRHR of 0 beats/min, the adjusted risk of T2DM was significantly increased with RHR increment and reduced with RHR reduction. ΔRHR was positively associated with future risk of T2DM [RR per unit increase: 1.03 (1.03-1.04)]. As compared with stable change in RHR group (-5<ΔRHR<5 beats/min), for ΔRHR ≤ -10 beats/min, -10<ΔRHR ≤ -5 beats/min, 5≤ΔRHR<10 beats/min, and ΔRHR ≥10 beats/min groups, the pooled adjusted RR (95% CI) of T2DM was 0.69 (0.55-0.86), 0.90 (0.73-1.11), 1.31 (1.07-1.61), and 1.90 (1.59-2.26), respectively. This significant association still existed on subgroup analyses based on age, sex, and baseline RHR and sensitivity analyses.Conclusions: Dynamic RHR change was significantly associated with incident T2DM. Our study suggests that RHR may be a non-invasive clinical indicator for interventions aiming to reduce incident T2DM in the general population. [ABSTRACT FROM AUTHOR]

Heart rate variability (HRV) and resting heart rate (RHR) are usually analyzed and interpreted separately. We aimed to assess the interplay of HRV and RHR on mortality in type 2 diabetes. The study included 7,529 participants from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. HRV metrics included standard deviation of all normal-to-normal intervals (SDNN) and root mean square of successive differences between normal-to-normal intervals (rMSSD). Abnormal values were defined based on <25th percentile for HRV and >75th percentile for RHR. Interactions of HRV status and RHR status were tested on multiplicative and additive scales. Results were validated in a subset of patients with type 2 diabetes (n = 745) from the Multi-Ethnic Study of Atherosclerosis. Low SDNN was associated with increased all-cause mortality in the high RHR group (HR 1.60; 95% CI 1.29–1.97), but not in the normal RHR group. Compared with those who had neither low SDNN nor high RHR, the presence of either low SDNN or high RHR was not significantly associated with an increased risk of all-cause mortality. In contrast, the combination of low SDNN and high RHR was associated with a significantly increased risk of all-cause mortality (HR 1.68; 95% CI 1.43–1.97). Significant multiplicative and additive interactions were found between HRV status and RHR status on risk of all-cause mortality (all P interaction < 0.05). Similar findings were observed for cardiovascular mortality, in analyses using rMSSD, and in the Multi-Ethnic Study of Atherosclerosis. The association between HRV and mortality risk is modified by RHR levels. Furthermore, low HRV and high RHR have interdependent and synergistic associations with mortality risk. • Both low heart rate variability and high resting heart rate are predictive of subsequent mortality in type 2 diabetes. • Despite their wide use, heart rate variability and resting heart rate are usually analyzed and interpreted separately. • The association between heart rate variability and mortality risk is modified by resting heart rate levels. • Heart rate variability and resting heart rate have interdependent and synergistic associations with mortality risk. [ABSTRACT FROM AUTHOR]

Abstract Elevated resting heart rate (RHR) and obesity are important risk factors for hypertension. However, studies are rare on the combined impact of RHR and obesity on prehypertension and hypertension. This study aimed to investigate the association between RHR and hypertension with different waist-to-height ratio (WHtR) in Chinese. The population-based cross-sectional study was conducted during 2013-2015 in Henan province, China, and 15,536 participants aged ≥15 years were included. RHR was classified according to sex-specific quartiles. The cutoff value of WHtR was 0.5 in both sexes. Multilinear and multilogistic regression models were used to evaluate the association of RHR and WHtR with prehypertension and hypertension. In both sexes, higher RHR was associated with higher blood pressure and lower pulse pressure. Compared with the lowest RHR quartile, participants in the highest RHR quartile had an increased risk of prehypertension (odds ratio [OR]: 1.40, 95% confidence interval [CI]: 1.18–1.65; OR: 1.27, 95% CI: 1.09–1.48) and hypertension (OR: 1.75, 95% CI: 1.43–2.15; OR: 1.36, 95% CI: 1.13–1.63) for male and female, respectively, after fully adjusting the data. In addition, adjusted ORs for prehypertension and hypertension of participants with high WHtR and high RHR were 2.91 (95% CI: 2.38–3.55) and 6.28 (4.96–7.97) for male and 2.45 (2.05–2.93) and 4.63 (3.66–5.85) for female, respectively, compared with the normal WHtR and normal RHR. In conclusion, elevated RHR was significantly associated with the risk of prehypertension and hypertension in Chinese and WHtR as a measure of abdominal obesity further increased this association. Highlights • Elevated resting heart rate (RHR) was associated with the risk of hypertension. • High waist-to-height ratio increased the association of RHR with hypertension, particularly for male. • The population with high RHR and high waist-to-height ratio should be highlighted in preventing hypertension. [ABSTRACT FROM AUTHOR]

Abstract Background Higher resting heart rate (RHR) was associated with poor prognosis in breast cancer survivors, but the mechanism underlying such association has not been fully studied. We investigated the association between RHR and metabolic risk factors in stage I-III breast cancer survivors. Methods Among 11,013 women diagnosed with breast cancer between 2005 and 2013 at the Severance hospital in Seoul, Korea, a total of 4980 patients met our inclusion criteria for the final analysis. Multivariable linear regressions were used to examine the association between RHR and metabolic risk factors, including systolic blood pressure (SBP), diastolic blood pressure (DBP), glucose, triglyceride (TG), total cholesterol, high density lipid cholesterol (HDL C), and low density lipid cholesterol. Results The results showed that RHR had significant linear associations with SBP (p =.02), DBP (p <.001), TG (p <.001), glucose (p <.001), and HDL-C (p <.001). Compared to participants in the lowest quintile of RHR (<68 beat per min (bpm)), participants in the highest quintile (≥85 bpm) had higher DBP by 4 mmHg, TG by 13 mg/dl, and glucose by 5 mg/dl after adjusting for potential confounders. Further subgroup analyses showed that the association of RHR may differ by age and menopausal status for fasting glucose and cancer stage, chemotherapy, estrogen and progesterone receptor status for TG. Conclusions We observed a strong positive association of RHR with fasting glucose, TG, and DBP in breast cancer survivors, which may potentially explain the association between RHR and breast cancer prognosis. Highlights • Underlying mechanism of resting heart rate (RHR) and cancer prognosis is unclear. • Higher RHR was associated with higher glucose in breast cancer survivors. • Higher RHR was associated with higher triglyceride in breast cancer survivors. • Higher RHR was associated with higher diastolic blood pressure in breast cancer survivors. • RHR may be a predictor of metabolic risk factors associated with cancer prognosis. [ABSTRACT FROM AUTHOR]

Summary Introduction We investigated the associations between total and different domains of physical activity and resting heart rate in adolescents. Summary of facts and results The sample was composed of 716 girls and 515 boys aged between 14 to 17 (15.55 ± 1.07) years. Resting heart rate was evaluated using an oscillometric device. Physical activity was assessed using a questionnaire, taking into consideration the different domains (leisure and sports practice). The relationship between resting heart rate and the different physical activity domains was analyzed by means of Linear Regression. After adjustment for body mass index, total physical activity (β = −0.54) and sports practice (β = −0.62) were inversely associated with high resting heart rate. Conclusion Results indicate that practice of sports constitutes an important tool against high resting heart rate values. [ABSTRACT FROM AUTHOR]

Background We examined the independent and cumulative associations of resting heart rate and pulse pressure with metabolic syndrome in Chinese rural population based on epidemiological research. Methods A total of 38,708 participants were derived from the Henan Rural Cohort study. Restricted cubic splines and logistic regression model were used to estimate the odds ratios and 95% confidence intervals of metabolic syndrome risk in relation to resting heart rate and pulse pressure. Results After adjusting for potential confounders, the odds ratio (95% confidence intervals) of resting heart rate and pulse pressure in the highest quartile with the risk of metabolic syndrome were 1.59 (1.48–1.70) and1.81 (1.67–1.95), respectively. Simultaneously, the cumulative effect analysis indicated that the adjusted the odd ratio of resting heart rate and pulse pressure in the highest quartile was 2.89 (2.40–3.47). Furthermore, there was a significantly additive interaction between resting heart rate and pulse pressure on the risk of metabolic syndrome. Conclusion Increased resting heart rate and pulse pressure are associated with the higher risk of metabolic syndrome as well as the influences of resting heart rate with pulse pressure might cumulatively increase the risk of metabolic syndrome. However, the potential clinical application remains to be determined. [ABSTRACT FROM AUTHOR]

Background and aims Left-sided valvular calcification is associated with cardiovascular disease (CVD) morbidity and mortality. Resting heart rate (RHR) may influence valvular calcium progression through shear stress. Whether RHR, an established CVD risk factor, is associated with valvular calcium progression is unknown. We assessed whether RHR predicts incidence and progression of mitral annular calcium (MAC) and aortic valve calcium (AVC) in a community-based cohort free of CVD at baseline. Methods RHR was obtained from baseline electrocardiograms of 5498 MESA participants. MAC and AVC were quantified using Agatston scoring from cardiac computed tomography scans obtained at baseline and at a second examination during follow-up. We examined associations of RHR with incident MAC/AVC and annual change in MAC/AVC scores, after adjusting for demographics, CVD risk factors, physical activity, and atrioventricular nodal blocker use. Results At baseline, participants had mean age of 62 ± 10 years and mean RHR of 63 ± 10 bpm; 12.3% and 8.9% had prevalent AVC and MAC, respectively. Over a median of 2.3 years, 4.1% and 4.5% developed incident AVC and MAC, respectively. Each 10 bpm higher RHR was significantly associated with incident MAC [Risk Ratio 1.17 (95% CI 1.03–1.34)], but not incident AVC. However, RHR was associated with AVC progression [β = 1.62 (0.45–2.80) Agatston units/year for every 10 bpm increment], but not MAC progression. Conclusions Higher RHR was associated with MAC incidence and AVC progression, independent of traditional CVD risk factors. Future studies are needed to determine whether modification of RHR through lifestyle or pharmacologic interventions can reduce valvular calcium incidence or progression. [ABSTRACT FROM AUTHOR]

Aim To investigate the association of resting heart rate (RHR) measured in late adolescence with the long term risk of myocardial infarction (MI), ischemic stroke (IS), heart failure (HF), atrial fibrillation (AF), cardiovascular- and all-cause death. Methods and results We followed a cohort of Swedish men enrolled for conscription in 1968–2005 (n = 1,008,485; mean age = 18.3 years) until December 2014. Outcomes were collected from the national inpatient - (IPR), outpatient - (OPR) and cause of death registries. Cox proportional hazard models were used to analyze the longitudinal association between RHR and outcomes while adjusting for potential confounders. While we found no independent association between RHR and risk of IS or MI when comparing the highest with the lowest quintile of the RHR distribution, but a positive association persisted between RHR and incident HF (Hazard ratio (HR) = 1.39 [95% confidence interval (CI) = 1.29–1.49]) after adjustment for body mass index (BMI) and blood pressure (BP). In similarly adjusted models, an inverse association was found for AF while there were weaker associations with death from cardiovascular disease (CVD) and all causes (adjusted HR = 1.12 [CI = 1.04–1.21] and 1.20 [CI = 1.17–1.24]). After further adjustment for cardiorespiratory fitness (CRF), the associations persisted for HF (HR = 1.26 [1.17–1.35] for any diagnostic position and HR = 1.43 [1.28–1.60] for HF as a main diagnosis) and for all-cause death (HR 1.09 [1.05–1.12]) but not for CVD death. Conclusion Adolescent RHR is associated with future risk of HF and death, independently of BP, BMI and CRF, but not with CVD death, MI or IS, suggesting a causal pathway between elevated heart rate and myocardial dysfunction. [ABSTRACT FROM AUTHOR]

From the literature it is not clear whether low resting heart rate (HR) reflects low or high sensitivity to the detrimental effects of adverse environments on externalizing problems. We studied parental psychiatric history (PH), reflecting general vulnerability, as possible moderator explaining these inconsistencies. Using Linear Mixed Models, we analyzed data from 1914 subjects, obtained in three measurement waves (mean age 11, 13.5, and 16 years) from the TRacking Adolescents’ Individual Lives Survey population-based cohort and the parallel clinic-referred cohort. As hypothesized, more chronic stressors predicted more externalizing problems in vulnerable individuals with high resting HR but not in those with low resting HR, suggesting high vs. low sensitivity, respectively, to adverse environmental influences. Low sensitivity to adverse environmental influences in vulnerable individuals exposed to high stressor levels was additionally confirmed by high heart rate variability (Root Mean Squared Successive Difference; RMSSD). In adolescents with low vulnerability, in contrast, the association between chronic stressors and externalizing problems did not substantially differ by resting HR and RMSSD. Future research may demonstrate whether our findings extend to other adverse, or beneficial, influences. Notwithstanding their theoretical interest, the effects were small, only pertained to parent-reported externalizing problems, refer to a small subset of respondents in our sample, and are in need of replication. We conclude that HR and RMSSD are unlikely to be strong moderators of the association between stressors and externalizing problems. [ABSTRACT FROM AUTHOR]

This study explored a psychophysiological measure, Resting Heart Rate (RHR), as a predicator of the ability to detect lies. RHR was recorded for 1 min and followed by a deception detection task in which participants were required to judge 24 videos of people describing a real-life event (50% truthful, 50% deceptive). Multiple regression analyses showed that, among other individual characteristics, only RHR predicted the ability to distinguish truth from lies. Importantly, the prediction was negative. This result suggests that the higher the RHR, the worse the detection of lies. Since the RHR is considered to be a physiological trait indexing autonomous arousal, and since high-arousal states can lead to restricted attentional resources, we suggest that limited selection and utilization of cues due to restricted attention is the reason why higher RHR leads to poor deception detection. [ABSTRACT FROM AUTHOR]

Background and Purpose: It remains unclear whether resting heart rate (RHR), particularly cumulative exposure to resting heart rate (cumRHR), is associated with stroke. The aim of our study was to prospectively explore the relationship between cumRHR and stroke morbidity.Materials and Methods: The Kailuan study is a prospective longitudinal cohort study on cerebrovascular events and cardiovascular factors. Hazard ratios (HRs) with 95% confidence interval (CI) were calculated using a Cox competing risk model.Results: A total of 46,568 participants were included in the final analysis. In the observation population, we identified 851 stroke events and 1012 incident death cases in the 4.98 ± .51 year followed-up. Each 46.74 (beats/min) × year increase in heart rate was associated with a 12% increase in the risk of stroke (HR = 1.12, 95% CI = 1.05-1.20). In the categorical model, the highest quartile had an increased risk of stroke (HR = 1.43, 95% CI = 1.13-1.81), compared with the bottom quartile. Gender and age had no interaction with cumRHR for the risk of stroke.Conclusion: Increase of exposure to cumulative heart rate is independently associated with a higher risk of stroke in the general population. [ABSTRACT FROM AUTHOR]

In this paper, we describe a non-invasive and non-contact system of estimating resting heart rate (RHR) using a pyroelectric infrared (PIR) sensor. This infrared system monitors and records the chest motion of a subject using the analog output signal of the PIR sensor. The analog output signal represents the composite motion due to inhale-exhale process with magnitude much larger than the minute vibrations of heartbeat. Since the acceleration of the heart activity is much faster than breathing the second derivative of the PIR sensor signal monitoring the chest of the subject is used to estimate the resting heart rate. Experimental results indicate that this ambient sensor can measure resting heart rate with a chi-square significance level of α = 0.05 compared to an industry standard PPG sensor. This new system provides a low cost and an effective way to estimate the resting heart rate, which is an important biological marker. [ABSTRACT FROM AUTHOR]

Background/Objective: The present study aimed to investigate the association between metabolic syndrome and cardiorespiratory fitness according to resting heart rate of Korean male adults. Methods: A total of 11,876 male adults aged 20-65 years who underwent health examinations from 2010 to 2015 at a National Fitness Centre in South Korea were included. Subjects' resting heart rate, cardiorespiratory fitness (VO2max), and metabolic syndrome parameters were collected. The subjects were divided into 5 categories (<60 bpm, 60e69 bpm, 70e79 bpm, 80e89 bpm, and ≥90 bpm) of resting heart rate for further analysis. Results: We found that elevated resting heart rate was positively associated with body mass index, systolic blood pressure, diastolic blood pressure, triglycerides, and fasting blood glucose levels (p < 0.001, respectively); in contrast, elevated resting heart rate was inversely associated with VO2max (p < 0.001). When resting heart rate of subjects was categorized into quintiles and analysed, the results showed that the relative risk of metabolic syndrome was 1.53-fold higher (95% CI, 1.34 to 1.82) in the range of 60-69 beats per minute (bpm), 2.08-fold higher (95% CI, 1.77 to 2.45) in the range of 70e79 bpm, 2.28-fold higher (95% CI, 1.73 to 3.00) in the range of 80e89 bpm, and 2.61-fold higher (95% CI, 1.62 to 4.20) in the range of ≥90 bpm, compared to those <60 bpm; this indicated that as resting heart rate increased, the relative risk of metabolic syndrome also increased. Conclusion: Resting heart rate of male adults was found to be associated with cardiorespiratory fitness; the risk factors for metabolic syndrome and relative risk of metabolic syndrome increased as resting heart rate increased. [ABSTRACT FROM AUTHOR]

Background Studies have demonstrated an increased risk of cardiovascular disease (CVD)-associated death (CVD death) with increased resting heart rate (RHR); however, whether the association is consistent in rural Chinese with hypertension and normotension is unknown. We examined the association of RHR and CVD death by hypertension and normotension status in rural Chinese people. Methods Baseline data for 20,069 participants ≥18 years old were collected during July to August of 2007 and July to August of 2008; 17,151 (85.5%) participants were followed up in July to August of 2013 and July to October of 2014. The association of RHR and CVD death was determined by Cox proportional hazards regression. Results During a mean of 5.88 years (100,889 person-years) of follow-up, we recorded 479 CVD deaths (309 in hypertensive participants). CVD death increased significantly with increasing RHR, beginning from 80 beats per minute (bpm), for hypertensive and normotensive participants. After adjusting for pulse pressure and other covariates, for hypertensive participants, risk of CVD death was increased with RHR 80–89 and ≥90 bpm. However, for normotensive participants, risk of CVD death was increased with only RHR ≥ 90 bpm. Conclusions Risk of CVD death was associated with elevated RHR for both hypertensive and normotensive rural Chinese, and for hypertensive participants, even slightly elevated RHR was associated with CVD death. [ABSTRACT FROM AUTHOR]

The world is slowly recovering from the Coronavirus disease 2019 (COVID-19) pandemic; however, humanity has experienced one of its According to work by Mishra et al. (2020), the study's first phase included a cohort of 5,262 subjects, with 3,325 Fitbit users constituting the majority. However, among this large cohort of 5,262 subjects, most significant trials in modern times only to learn about its lack of preparedness in the face of a highly contagious pathogen. To better prepare the world for any new mutation of the same pathogen or the newer ones, technological development in the healthcare system is a must. Hence, in this work, PCovNet+, a deep learning framework, was proposed for smartwatches and fitness trackers to monitor the user's Resting Heart Rate (RHR) for the infection-induced anomaly. A convolutional neural network (CNN)-based variational autoencoder (VAE) architecture was used as the primary model along with a long short-term memory (LSTM) network to create latent space embeddings for the VAE. Moreover, the framework employed pre-training using normal data from healthy subjects to circumvent the data shortage problem in the personalized models. This framework was validated on a dataset of 68 COVID-19-infected subjects, resulting in anomalous RHR detection with precision, recall, F-beta, and F-1 score of 0.993, 0.534, 0.9849, and 0.6932, respectively, which is a significant improvement compared to the literature. Furthermore, the PCovNet+ framework successfully detected COVID-19 infection for 74% of the subjects (47% presymptomatic and 27% post-symptomatic detection). The results prove the usability of such a system as a secondary diagnostic tool enabling continuous health monitoring and contact tracing. • A CNN-VAE-based anomaly detection model and an LSTM network to generate temporal-aware embeddings of the latent vector of the primary model is used. • Healthy patient data is used to pretrain the base model and fine-tuned using each subject's baseline data to achieve a personalized version. • The proposed model is validated on 68 COVID-19-infected individuals' data. [ABSTRACT FROM AUTHOR]

Introduction Resting heart rate (RHR) declines with exercise training. Possible mechanisms include: 1) increased parasympathetic tone, 2) decreased responsiveness to beta-adrenergic stimulation, 3) decreased intrinsic heart rate or 4) combination of these factors. Objective To determine whether an increase in resting parasympathetic tone or decrease in response to beta-adrenergic stimulation contributes to the decrease in RHR with training. Methods 51 screened healthy subjects aged 18–32 (n = 20, mean age 26, 11 female) or 65–80 (n = 31, mean age 69, 16 female) were tested before and after 6 months of supervised exercise training. Heart rate response to parasympathetic withdrawal was assessed using atropine and beta-adrenergic responsiveness during parasympathetic withdrawal using isoproterenol. Results Training increased VO 2 max by 17% (28.7 ± 7.7 to 33.6 ± 9.20 ml/kg/min, P < 0.001). RHR decreased from 62.8 ± 6.6 to 57.6 ± 7.2 beats per minute (P < 0.0001). The increase in heart rate in response to parasympathetic withdrawal was unchanged after training (+ 37.3 ± 12.8 pre vs. + 36.4 ± 12.2 beats per min post, P = 0.41). There was no change in the heart rate response to isoproterenol after parasympathetic blockade with training (+ 31.9 ± 10.9 pre vs. + 31.0 ± 12.0 post beats per min, P = 0.56). The findings were similar in all four subgroups. Conclusions We did not find evidence that an increase in parasympathetic tone or a decrease in responsiveness to beta-adrenergic activity accounts for the reduction in resting heart rate with exercise training. We suggest that a decline in heart rate with training is most likely due to decrease in the intrinsic heart rate. [ABSTRACT FROM AUTHOR]

Background and aims Higher cortisol levels are associated with cardiovascular mortality in the elderly. It is unclear whether this association also exists in a general population of younger adults and for non-fatal cardiovascular events. Likewise, resting heart rate is associated with cardiovascular mortality, but fewer studies have also considered non-fatal events. The goal of this study was to investigate whether twenty-four-hour urinary cortisol (24-h UFC) levels and resting heart rate (RHR) predict major adverse fatal and non-fatal cardiovascular events (MACE) in the general population. Methods We used data from a subcohort of the PREVEND study, a prospective general population based cohort study with a follow-up of 6.4 years for 24-h UFC and 10.6 years for RHR. Participants were 3432 adults (mean age 49 years, range 28–75). 24-h UFC was collected and measured by liquid chromatography—tandem mass spectrometry. RHR was measured at baseline in a supine position for 10 min with the Dinamap XL Model 9300. Information about cardiovascular events and mortality was obtained from the Dutch national registry of hospital discharge diagnoses and the municipal register respectively. Results 24-h UFC did not significantly increase the hazard of MACE (hazard ratio = 0.999, 95% confidence interval = 0.993–1.006, p = 0.814). RHR increased the risk for MACE with 17% per 10 extra heart beats per minute (hazard ratio = 1.016, 95% confidence interval = 1.001–1.031, p = 0.036) after adjustment for conventional risk factors. Conclusions In contrast to 24-h UFC, RHR is a risk marker for MACE in the general population. [ABSTRACT FROM AUTHOR]

Objective Investigate the association of resting heart rate (RHR) with diabetes, hypertension and metabolic syndrome in a data set that represents the whole Korean adult population. Methods The data of 18,640 adults, that represent the whole Korean adult population, was used to examine the association of resting heart rate (RHR) with blood related variables, diabetes, hypertension and metabolic syndrome. Results Compared to participants with a RHR of < 60 beats per minute (bpm), participants with a RHR of ≥ 90 bpm had higher odds of diabetes {3.85 [95% confidence interval (CI) 2.14–6.90], 3.34 (95% CI 1.83–6.10)} and metabolic syndrome [3.55 (95% CI 2.19–5.74), 2.15 (95% CI 1.37–3.35)], for men and women, respectively. Furthermore, compared to the participants with normal BMI (< 23 kg/m 2 ) normal RHR (< 80 bpm), participants with high BMI (≥ 23 kg/m 2 ) high RHR (≥ 80 bpm) had higher odds of diabetes [2.51 (95% CI 1.83–3.46), 4.89 (95% CI 3.63–6.58)], hypertension [3.88 (95% CI 3.00–5.01), 2.61 (95% CI 2.07–3.28)], and metabolic syndrome [9.67 (95% CI 7.42–12.61), 13.09 (95% CI 10.25–16.73)], for men and women, respectively. RHR shows a positive dose response relationship with the prevalence of diabetes and metabolic syndrome. The combined association of RHR with BMI increases the potency of RHR as a marker of diabetes, hypertension and metabolic syndrome. Conclusions This study shows that RHR has an important role to play as a potential clinical measurement and prognostic marker. [ABSTRACT FROM AUTHOR]

While substantial intercultural research has investigated the antecedents of socio-cultural and psychological adjustment, we know comparatively less about the consequences, in particular, about physical health outcomes. We analyzed the data from surveys and medical examinations of 394 North Korean refugees adjusting to their new lives in South Korea to better understand the relationship among socio-cultural adjustment, psychological adjustment, and physical health. Specifically, we focused on resting heart rate, as an important indicator of physical health. Our results showed a positive association between socio-cultural adjustment and psychological adjustment. Furthermore, we detected a so called “inconsistent mediation” that socio-cultural adjustment had a positive direct effect and a negative indirect effect on resting heart rate via psychological adjustment. These findings imply a double-edged role of socio-cultural adjustment. On the one hand, socio-cultural adjustment to the fast-paced and stressful life in an industrialized country may reduce physical health; while on the other hand, it may improve mental health, which in turn results in better physical health. Additional results also revealed the direct and indirect influence of refugees’ employment status on resting heart rate, implying that refugees who work are better adjusted and have better health. Theoretical and practical implications are discussed. [ABSTRACT FROM AUTHOR]

Summary Objective Both serum uric acid (SUA) and resting heart rate (RHR) are positively associated with metabolic syndrome (MetS). However, little is known regarding the relationship between SUA and RHR. We aimed to investigate the relationship between SUA and RHR in the elderly with MetS. Methods With a retrospective observational analysis, 867 Chinese elderly subjects (437 males and 430 females) were divided into 4 groups according to SUA quartiles. We first investigated the relationship between SUA and MetS. Then we evaluated whether there is an independent association of SUA with RHR in these subjects. Results There were significant differences of MetS incidence in groups of Quartile 1–4 in male and female (all P < 0.01). Female had higher MtS incidence than male (53.49% versus 43.24%; P = 0.003). After adjusting age, sex and diuretics usage, SUA levels intimately correlate with RHR, creatinine, waist-to-height ratio, waist circumference, high-sensitivity C-reactive protein (hsCRP) and white blood cells (all r > 0.30, P < 0.05). When RHR exceeded 86 bpm, after adjusting for various known risk factors, Odds ratios of concomitant SUA level were 1.243, 1.908, and 2.194 in the second, third, and fourth urate quartile respectively compared to the first quartile. ROC curve analysis demonstrated statistically significant value of RHR for hyperuricemia diagnosis (area under the curve was 0.702 with 95% CI of 0.605–0.791, P = 0.000). Conclusion The SUA has significant correlation with RHR in MetS. RHR appears to be a potentially detective marker to predict the elevated SUA and cardio-metabolic risk in Chinese elderly. [ABSTRACT FROM AUTHOR]

Enhanced knowledge regarding modifiable risk factors for hip fractures are warranted. We aimed to study the associations between two indicators of physical fitness (resting heart rate and level of physical activity) in middle-aged individuals, and the risk of hip fractures during the subsequent three decades. Data on objectively measured resting heart rate and self-reported leisure time physical activity from a national health survey (1985–1999) was linked to a database including all hip fractures treated in Norwegian hospitals from 1994 through 2018. We calculated hazard ratios (HR) with 95 % confidence intervals (95 % CI) for hip fractures according to categories of resting heart rate (mean of two repeated measures), and leisure time physical activity level in adjusted Cox proportional hazard models. In total, 367,386 persons (52 % women) aged 40 to 45 years were included, of whom 5482 persons sustained a hip fracture during a mean follow-up of 24.8 years. Higher resting heart rate was associated with higher hip fracture risk. Men with a resting heart rate above 80 bpm, who also reported low levels of physical activity, had a HR of 1.82 (95 % CI 1.49–2.22) for hip fracture compared to men with a resting heart rate below 70 bpm who reported high levels of physical activity. The same measure of association for women was 1.62 (95 % CI 1.28–2.06). Physical fitness measured by low resting heart rate in middle age, and a high physical activity level were associated with a lower long-term risk of hip fractures in both men and women. [Display omitted] • A prospective study with heart rate registration in 400,000 middle-aged individuals • A high resting heart rate was associated with an increased risk of hip fracture. • Low levels of physical activity were also associated with increased facture risk. [ABSTRACT FROM AUTHOR]

Background: Elevated resting heart rate predicts poor cardiovascular and cerebrovascular outcomes. Atherosclerosis may be a mediator linking this relationship. In a Chinese population, we investigated whether resting heart rate was associated with carotid atherosclerosis as indicated by elevated carotid intima-media thickness (CIMT) and presence of carotid plaque.Methods: A total of 1557 participants older than 50 years old from a community-based population without known cardiovascular diseases were included. All participants provided detailed lifestyle and medical information, and blood samples for biochemical measurements. The participants were categorized according to resting heart rate quartiles (<67, 67-73, 74-81, >81 beats per minute [bpm]). CIMT and presence of carotid plaque were determined using B-mode ultrasonography. Elevated CIMT was defined as the upper quartile of CIMT.Results: We observed positively graded associations between resting heart rate quartiles and carotid atherosclerosis. Participants with resting heart rates higher than 81 bpm had an odds ratio of 2.82 (95% confidence interval 1.92-4.13) for elevated CIMT, and an odds ratio of 2.00 (1.36-2.92) for carotid plaque, compared to participants with resting heart rates lower than 67 bmp. Each 10-bpm increase in resting heart rate was associated with an odds ratio of 1.47 (1.29-1.68) for elevated CIMT and an odds ratio of 1.40 (1.23-1.60) for carotid plaque. The associations were independent of conventional cardiovascular risk factors.Conclusions: Elevated resting heart rate was strongly and independently associated with carotid atherosclerosis in the middle-aged and elderly Chinese population. Atherosclerosis may be a potential mediator between resting heart rate and adverse cardiovascular outcomes. [ABSTRACT FROM AUTHOR]

Objective Elevated resting heart rate (RHR) has been shown to be a risk marker for cardiovascular disease. Results from studies on the effects of RHR in large arteries are limited to the functional changes of those arteries, while the association between RHR and aortic diameter remains largely understudied. Methods This was a cross sectional study of hypertensive Chinese adults from rural areas. The maximum infrarenal aortic diameter (maxIAD) from renal arteries to the iliac bifurcation was obtained by ultrasound. MaxIADs in different RHR groups were compared in males and females separately because of the significant differences between sexes. Multiple regression analysis was used to determinate the correlation between RHR and maxIAD. Further interactions between three factors (BMI, smoking, and anti-hypertensive regimens) and RHR for maxIAD were examined using subgroup analysis. Results 19,200 subjects were enrolled in the study, with an average age of 64.8±7.4 years and 61.6% females. Only 22 cases (0.11%) were detected with AAA, with males ( n = 17) presenting a higher AAA incidence than females ( n = 5). In subjects ≥65 years, there were 18 (0.19%) AAA, and 15 (83.3%) had a history of smoking. In the total subjects, the mean maxIAD ranged from 15.7±2.1 mm to 15.2±2.2 mm as RHR changed from the lowest quartile to the highest (≥84 bpm) in males, with a similar tendency observed in females. The correlation coefficient of RHR on maxIAD was −0.17 in males and −0.12 in females. Further subgroup analysis revealed that smoking exaggerated the correlation between RHR and maxIAD, but only in females. Conclusions A low AAA incidence was observed in this hypertensive Chinese population. There was a negative association between RHR and maxIAD, potentially exaggerated by smoking, especially in females. [ABSTRACT FROM AUTHOR]

Background High resting heart rate has been associated with increased risk of type 2 diabetes in several studies, but the available data are not consistent and it is unclear if there is a dose–response relationship between resting heart rate and type 2 diabetes risk. We aimed to clarify this association by conducting a systematic review and meta-analysis of published studies. Methods and results PubMed, Embase and Ovid Medline databases were searched for prospective studies published up until October 11th, 2013. Summary relative risks were estimated using a random effects model. Ten cohort studies with >5628 cases and 119,915 participants were included. The summary RR for high vs. low resting heart rate was 1.83 (95% CI: 1.28–2.60, I 2 = 88%, n = 7), and in the dose–response analysis the summary RR was 1.20 (95% CI: 1.07–1.34, I 2 = 93%, n = 9) for an increase of 10 beats per minute. The heterogeneity was to a large degree explained by two studies. There was evidence of nonlinear associations between resting heart rate ( p nonlinearity < 0.0001) and risk of type 2 diabetes. Conclusion The current meta-analysis indicates a strong positive association between high resting heart rate and the risk of type 2 diabetes. As a non-invasive marker of type 2 diabetes risk, resting heart rate may have potential in the clinical setting, especially for interventions aimed at lowering the risk of type 2 diabetes. Additional studies are needed to clarify the mechanisms that may be responsible for the assoiation between resting heart rate and type 2 diabetes. [ABSTRACT FROM AUTHOR]

Recent large epidemiological studies have confirmed that an elevated resting heart rate is an independent predictor of cardiovascular and overall mortality in the general population as well as in patients with hypertension, coronary heart disease and chronic heart failure. Pathophysiological studies indicate that a higher heart rate has detrimental effects that favor myocardial ischemia, ventricular arrhythmias, as well as an increase in vascular oxidative stress, endothelial dysfunction and atherosclerosis progression. Benefits of heart rate lowering drugs, such as beta-blockers and ivabradine, in reducing overall and cardiovascular-related mortality, have been demonstrated particularly in patients with coronary heart disease and heart failure. However, despite these evidences, resting heart rate is still an overlooked cardiovascular risk factor. [ABSTRACT FROM AUTHOR]

Background: Elevated resting heart rate (RHR) is a predictor of incident type 2 diabetes (T2D). Insulin resistance is thought to play a role in this association; however, the extent to which insulin resistance mediates this association is unclear.Methods: 1309 Japanese individuals without diabetes were recruited during 2009-2012 and followed for 5 years, of whom 78 developed T2D, as diagnosed by the 75 g oral glucose tolerance test. Supine RHR was measured by electrocardiography. Using logistic regression analysis, we examined the association between RHR and incident T2D, and interaction with the homeostasis model assessment of insulin resistance (HOMA-IR) index. Causal mediation analysis was applied to decompose the effect of RHR on the outcome and estimate the proportion mediated by the HOMA-IR index.Results: The sex- and age-adjusted cumulative incidence rate of T2D increased with increasing RHR. After adjustment for sex, age, waist circumference, current smoking status, alcohol use, habitual exercise, and cardiovascular disease medications, individuals with a RHR ≥80 bpm, compared with <60 bpm, showed an increased risk of incident T2D [odds ratio (OR), 2.89; 95 % confidence interval (CI), 1.07 to 7.80]. Multivariate adjusted OR for the total effect per 1 SD increase in RHR on incident T2D was 1.37 (95 % CI, 1.01 to 1.74) in the mediation analysis, and the proportion of the total indirect effect mediated by the HOMA-IR index was 27.5 % (95 % CI, 1.5 to 53.5).Conclusions: Approximately 30 % of the effect of RHR on incident T2D was explained by the indirect effect of insulin resistance. [ABSTRACT FROM AUTHOR]

Background An elevated resting heart rate (RHR) may be an early sign of cardiac failure, but its prognostic value during watchful waiting in asymptomatic aortic stenosis (AS) is largely unknown. Methods RHR was determined by annual ECGs in the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study of asymptomatic mild-to-moderate AS patients. Primary endpoint in this substudy was major cardiovascular events (MCEs) and secondary outcomes its individual components. Multivariable Cox-models using serially-measured RHR were used to examine the prognostic impact of RHR per se. Results 1563 patients were followed for a mean of 4.3 years (6751 patient-years of follow-up), 553 (35%) MCEs occurred, 10% (n = 151) died, including 75 cardiovascular deaths. In multivariable analysis, baseline RHR was independently associated with MCEs (HR 1.1 per 10 min-1 faster, 95% CI: 1.0-1.3) and cardiovascular mortality (HR 1.3 per 10 min-1 faster, 95% CI: 1.0-1.7, both p ≤ 0.03). Updating RHR with annual in-study reexaminations, time-varying RHR was highly associated with excess MCEs (HR 1.1 per 10 min-1 faster, 95% CI: 1.1-1.3) and cardiovascular mortality (HR 1.4 per 10 min-1 faster, 95% CI: 1.2-1.7, both p ≤ 0.006). The association of RHR with MCEs and cardiovascular mortality was not dependent on atrial fibrillation status (both p ≥ 0.06 for interaction). Conclusions RHR is independently associated with MCEs and cardiovascular death in asymptomatic AS (Clinicaltrials.gov; unique identifier NCT00092677). [ABSTRACT FROM AUTHOR]

Background: Previous studies suggest that elevated resting heart rate (RHR) is related to an increased risk of cancer mortality. The aim of this study was to evaluate the relation between RHR and cancer incidence and mortality in patients with vascular disease. Methods: Patients with manifest vascular disease (n = 6007) were prospectively followed-up for cancer incidence and mortality. At baseline, RHR was obtained from an electrocardiogram. The relation between RHR and cancer incidence, cancer mortality and total mortality was assessed using competing risks models. Results: During a median follow-up of 6.0 years (interquartile range: 3.1-9.3) 491 patients (8%) were diagnosed with cancer and 907 (15%) patients died, 248 (27%) died from cancer. After adjustment for potential confounders, the hazard ratio (HR) for incident cancer per 10 beats/min increase in RHR was 1.00 (95% confidence interval [CI]: 0.93-1.07). There was a trend toward an increased risk of colorectal cancer in patients with higher RHR (HR 1.15, 95% CI 0.97-1.36). The risk of all-cause mortality was increased in patients in the highest quartile of RHR compared to the lowest quartile (HR 1.86, 95% CI 1.53-2.27), but no effect of RHR on cancer mortality was observed (HR 1.01, 95% CI 0.70-1.46). Conclusions: In patients with manifest vascular disease, elevated RHR was related to a higher risk of premature all-cause mortality, but this was not due to increased cancer mortality. RHR was not related to risk of overall cancer incidence, although a relation between elevated RHR and incident colorectal cancer risk could not be ruled out. [ABSTRACT FROM AUTHOR]

Abstract: Background: Recent studies suggested that resting heart rate (RHR) might be an independent predictor of cardiovascular mortality and morbidity. Nonetheless, the interrelation between RHR and cardiovascular diseases is not clear. In order to resolve this puzzle, the importance of genetic determinants of RHR has been recently suggested, but it needs to be further investigated. Objective: The aim of this study was to estimate the contribution of common genetic variations on RHR using Genome Wide Association Study. Methods: We performed a Genome Wide Association Study in an isolated population cohort of 1737 individuals, the Italian Network on Genetic Isolates — Friuli Venezia Giulia (INGI-FVG). Moreover, a haplotype analysis was performed. A regression tree analysis was run to highlight the effect of each haplotype combination on the phenotype. Results: A significant level of association (p<5×10−8) was detected for Single Nucleotide Polymorphisms (SNPs) in two genes expressed in the heart: MAML1 and CANX. Founding that the three different variants of the haplotype, which encompass both genes, yielded a phenotypic correlation. Indeed, a haplotype in homozygosity is significantly associated with the lower quartile of RHR (RHR≤58bpm). Moreover no significant association was found between cardiovascular risk factors and the different haplotype combinations. Conclusion: Mastermind-like 1 and Calnexin were found to be associated with RHR. We demonstrated a relation between a haplotype and the lower quartile of RHR in our populations. Our findings highlight that genetic determinants of RHR may be implicated in determining cardiovascular diseases and could allow a better risk stratification. [Copyright &y& Elsevier]

Objectives: The objective of this study was to investigate the relationship between baseline resting heart rate and incidence of heart failure (HF) and global and regional left ventricular (LV) dysfunction. Background: The association of resting heart rate to HF and LV function has not been well described in an asymptomatic multi-ethnic population. Methods: Resting heart rate was measured in participants in the MESA (Multi-Ethnic Study of Atherosclerosis) trial at inclusion. Incident HF was registered (n = 176) during follow-up (median 7 years) in those who underwent cardiac magnetic resonance imaging (n = 5,000). Changes in ejection fraction (ΔEF) and peak circumferential strain (Δεcc) were measured as markers of developing global and regional LV dysfunction in 1,056 participants imaged at baseline and 5 years later. Time to HF (Cox model) and Δεcc and ΔEF (multiple linear regression models) were adjusted for demographics, traditional cardiovascular risk factors, calcium score, LV end-diastolic volume, and mass in addition to resting heart rate. Results: Cox analysis demonstrated that for 1 beat/min increase in resting heart rate, there was a 4% greater adjusted relative risk for incident HF (hazard ratio: 1.04; 95% CI: 1.02 to 1.06; p < 0.001). Adjusted multiple regression models demonstrated that resting heart rate was positively associated with deteriorating εcc and decrease in EF, even when all coronary heart disease events were excluded from the model. Conclusions: Elevated resting heart rate was associated with increased risk for incident HF in asymptomatic participants in the MESA trial. Higher heart rate was related to development of regional and global LV dysfunction independent of subclinical atherosclerosis and coronary heart disease. (Multi-Ethnic Study of Atherosclerosis [MESA]; NCT00005487) [Copyright &y& Elsevier]

Abstract: Background: Resting heart rate (RHR) reflects sympathetic nerve activity and is independently related to the occurrence of cardiovascular events and death in healthy subjects, patients with coronary artery disease (CAD) and patients with cardiovascular risk factors. We investigated and compared the risk of RHR on the occurrence of cardiovascular events and death in patients with CAD, cerebrovascular disease (CVD), peripheral arterial disease (PAD) or abdominal aortic aneurysm (AAA). Methods: Data were used from a prospective cohort study of 4272 patients with manifest vascular disease: CAD (n=2244), CVD (n=930), PAD (n=823) or AAA (n=275). RHR was obtained at baseline from an electrocardiogram. The median follow-up time was 4.4 (interquartile range 2.1–7.4) years. The relation between RHR and the occurrence of cardiovascular events and death was estimated by Cox proportional hazard analyses. Results: Each increase in RHR of 10beats/min was related to an increased risk for all-cause mortality (hazard ratio (HR) 1.14; 95% confidence interval (CI) 1.07–1.21) and vascular mortality (HR 1.15; 95% CI 1.06–1.25), but not for myocardial infarction (HR 1.03; 95% CI 0.94–1.14) or ischemic stroke (HR 1.05; 95% CI 0.92–1.20). The relation between an increased RHR and increased risk for all-cause mortality was present irrespective of beta-blocker use and irrespective of the location of vascular disease: CAD (HR 1.23; 95% CI 1.05–1.44), CVD (HR 1.18; 95% CI 1.05–1.33) and PAD/AAA (HR 1.10; 95% CI 1.01–1.20). Conclusions: Elevated RHR is associated with increased risk for mortality but not for myocardial infarction or stroke in patients with manifest vascular diseases irrespective of location of vascular disease. [Copyright &y& Elsevier]

Cardiovascular risk of increased heart rate (HR) was first reported in the Framingham study. Thereafter, the risk of increased HR for mortality has been extensively studied, suggesting the higher risk in clinical outcomes with increased HR in the general population and in patients with coronary artery disease or heart failure (HF). In a long-term follow-up study in Framingham, the general population in this cohort showed an increase in all-cause mortality by 14% at every 10 bpm increase in HR. In patients with heart failure, resting HR of more than 80 bpm could cause myocardial dysfunction which further deteriorates HF. Downregulation of β-adrenoreptor receptors with suppressed signal transductions, impaired intracellular Ca homeostasis, and excitation-contraction coupling may play a role in myocardial dysfunction. These subcellular alterations are mimicked in the pacing-induced HF in large animals; however, exact mechanisms of cardiac deterioration by increased HR are not fully understood. β-Blocker treatment is the most effective therapy for long-term survival of patients with chronic HF. Meta-analysis of HR reduction and improvement in survival in patients with chronic HF indicates that HR reduction is more important than the titrated dose of β-blockers, although the relative importance of HR reduction in improvement of prognosis is not clear. A recent study in which ivabradine decreased the hospitalization from HR deterioration in patients with chronic HF, demonstrated that further HR reduction with optimal treatment for HF is beneficial for clinical outcomes of the patients. These findings strongly suggest that HR reduction should be a pivotal target of the treatment in patients with HF. [ABSTRACT FROM AUTHOR]

Abstract: Background: Elevated resting heart rate is associated with mortality in general populations. Smokers may be at particular risk. The association between resting heart rate (RHR), smoking status and cardiovascular and total mortality was investigated in a general population. Methods: Prospective study of 16,516 healthy subjects from the Copenhagen City Heart Study. 8709 deaths, hereof 3821 cardiovascular deaths, occurred during 33years of follow-up. Results: In multivariate Cox models with time-dependent covariates RHR was significantly associated with both cardiovascular and total mortality. Current and former smokers had, irrespective of tobacco consumption, greater relative risk of elevated RHR compared to never smokers. The relative risk of all-cause mortality per 10bpm increase in RHR was (95% CI): 1.06 (1.01–1.10) in never smokers, 1.11 (1.07–1.15) in former smokers, 1.13 (1.09–1.16) in moderate smokers, and 1.13 (1.10–1.16) in heavy smokers. There was no gender difference. The risk estimates for cardiovascular and all-cause mortality were essentially similar. In univariate analyses, the difference in survival between a RHR in the highest (>80bpm) vs lowest quartile (<65bpm) was 4.7years in men and 3.6years in women. In multivariate analyses, the difference was about one year in never smokers and about two years in current and former smokers. Conclusions: In a healthy population resting heart rate is associated with total and cardiovascular mortality. Elevated resting heart rate is associated with greater risk in subjects with a history of smoking than in never smokers. [Copyright &y& Elsevier]

Abstract: Background: Elevated resting heart rate is associated with increased mortality in a variety of cardiac diseases, but comparisons between different clinical settings are lacking. We investigated the long-term prognostic importance of resting heart rate in patients hospitalized with left ventricular dysfunction in connection with either heart failure (HF) or myocardial infarction (MI). Methods: In the Danish Investigations and Arrhythmia ON Dofetilide (DIAMOND) study; patients with left ventricular dysfunction were randomized to Dofetilide (class III antiarrhythmic drug) or placebo. One part of the study enrolled 1518 patients with HF and another 1510 patients with MI. Mortality analyses were performed using multivariable adjusted Cox proportional hazard models. Results: During 10 years of follow-up, 1076 (72%) patients with MI and 1336 (89%) patients with HF died. In multivariable adjusted models, every increment in baseline heart rate of 10 bpm was associated with an increase in mortality in both MI-patients (hazard ratio, 1.14; 95%-confidence interval (CI): 1.09–1.19; P <.0001) and HF-patients (hazard ratio, 1.10; CI: 1.06–1.15; P <.0001). The importance of resting heart rate on short-term prognosis was stronger in the MI patients compared to the HF patients (P <.0001 for interaction). There was no interaction between heart rate and β-blockade, and inclusion of β-blockade in the model did not change the results. Conclusions: Resting heart rate was independently associated with increased risk of overall mortality. The prognostic importance of resting heart rate is stronger in patients with MI compared to patients with HF, especially in the short term. [Copyright &y& Elsevier]

While the neurotoxic effects of heavy metals at even low levels have been well-studied, few studies have examined the cardiovascular effects of heavy metals on resting heart rate and these have focused on adult populations. The present study aimed to examine the association between low-level environmental lead and mercury exposure and resting heart rate in community adolescents. As part of the China Jintan Cohort Study, 532 adolescents aged 12 years (SD = 0.6) were tested for blood levels of lead (BLL) and mercury (BML) and resting heart rate (RHR). Generalized linear models were conducted to test the relationship between BLL and BML and RHR, controlling for children's sex, age, and socioeconomic status. Analyses were clustered at the preschool level when the children were recruited to adjust for standard error. The mean (SD) BLL and BML were 3.14 (SD = 1.19) μg/dL and 1.26 (SD = 0.68) μg/L at age 12 years, respectively. After adjusting for confounders, we found a significant interaction between BML and BLL in predicting RHR in boys (B = -1.27, SE = 0.49, p < 0.01, n = 289). We created BLL and BML groups in boys based on median cut-offs. Boys in the High BLL/High BML group had significantly lower RHR (mean = 84.22 beats per minute [bpm], SD = 8.77, n = 61) than boys in the Low BLL/Low BML group (mean = 89.03 bpm, SD = 10.75, n = 69; p < 0.05). BML and BLL did not interact to predict RHR in girls (B = -0.18, SE = 0.88, p > 0.05, n = 242). Combined high BLL and BML were associated with low RHR in community adolescent boys. Low RHR is an indication of chronic under-arousal and has been implicated in psychopathology, particularly for externalizing behavior. Our findings may stimulate further communication and research in this area. [ABSTRACT FROM AUTHOR]

Abstract: We have recently found that serum level of pigment epithelium derived factor (PEDF) is significantly increased in proportion to the accumulation of the number of the components of the metabolic syndrome. Although high heart rate is also associated with metabolic risk factors for atherosclerosis, the correlation between serum level of PEDF and resting heart rate remains to be elucidated. In this study, we examined their relationship in Japanese outpatients. Four hundred two consecutive outpatients at Nakamura Clinic (141 male and 261 female; mean age 74.9±9.9) underwent a complete history and physical examination, determination of blood chemistries and PEDF levels. In multiple regression analysis, smoking (p =0.003), use of β-blockers (p =0.010, inversely), presence of atrial fibrillation (p =0.014), PEDF (p =0.018) and glucose levels (p =0.033) were independently correlated to resting heart rate. Further, when mean serum PEDF levels were stratified by resting heart rates, a linear and significant trend (p =0.025) was observed. The present study demonstrated for the first time that serum level of PEDF was one of the independent determinants of resting heart rate in Japanese outpatients. PEDF may play some role in sympathetic nerve activity. [Copyright &y& Elsevier]

In this study, 12 farmed Atlantic salmon (~1200 g) were tagged with commercially available heart rate (HR) bio-loggers and maintained in a controlled fish tank laboratory environment at 9 °C on a 12 h day/night cycle for 13 weeks. Apart from one fish that had obtained severe wounds on the tail region in the beginning, the remaining fish survived the entire test period and displayed consistent and similar HR in response to the day/night cycles with peak HR midday during feeding. At the end of the experiment, untagged conspecifics had significantly higher weights, fork lengths and conditions factors, showing the bio-logger may have a long term negative impact on growth. However, tagged fish still gained weight during the trial. Resting HR, as measured at night and early morning, decreased significantly over the first 2–3 weeks, and remained stable at ~25 beats min−1 between week 3 and 10, highlighting that substantial time is required for complete recovery following implantation of the bio-logger. At the start of week 11, 12 and 13, crowding stress trials of 30 min were performed which elevated HR to 55.7 beats min−1, whereafter it took 24 h to recover normal HR. Emerging bio-logger technologies can provide otherwise unobtainable information on the physiology and behaviour in free swimming individual fish over long periods and has great potential as welfare assessment tools in aquaculture. However, the impact of the tag must be considered with regards to the general representativeness of untagged counterparts when interpreting data. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to explore the association of resting heart rate (RHR) with type 2 diabetes mellitus (T2DM) by sex, and whether the association was mediated by insulin resistance (IR).Methods: This cross-sectional study enrolled 12,508 participants (median age 57 years), with information collection through questionnaire interview, anthropometric and laboratory measurements. Multivariable logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) of the association between RHR and T2DM by sex, and restricted cubic splines were used to describe the dose-response association. Mediation analysis was used to explore the contribution of IR, measured by homeostasis model assessment of insulin resistance (HOMA-IR) index, to RHR-related T2DM.Results: Among 12,508 participants, 1413 participants (11.30%) had T2DM. RHR was positively associated with T2DM (per 10-bpm increase in RHR, OR 1.48, 95% CI: 1.34-1.64 for men and OR 1.42, 95% CI: 1.32-1.52 for women). As compared with RHR = 75 bpm, with increasing RHR, the adjusted probability of T2DM was significantly increased for both men and women. HOMA-IR partially mediated the association (indirect effect: OR = 1.17, 95% CI:1.13-1.22; direct effect: OR = 1.25, 95% CI: 1.11-1.39 in men and indirect effect: OR = 1.16, 95% CI:1.13-1.20; direct effect: OR = 1.15, 95% CI: 1.15-1.35 in women).Conclusion: RHR was significantly associated with T2DM, which suggests that RHR may be a non-invasive clinical marker of early intervention to prevent T2DM, and IR may partially mediated RHR-related T2DM. [ABSTRACT FROM AUTHOR]