Heart rate, ischaemic heart disease, and sudden cardiac death in middle-aged British men.

A G Shaper, G Wannamethee, P W Macfarlane, M Walker

Department of Public Health and Primary Care, Royal Free Hospital School of Medicine, London.

OBJECTIVE--To examine the relation between resting heart rate and new major ischaemic heart disease events in middle aged men with and without pre-existing ischaemic heart disease. DESIGN--Prospective study of a cohort of men with eight years follow up for cardiovascular morbidity and mortality for all men. SETTING--General practices in 24 British towns (the British Regional Heart study). SUBJECTS--7735 men aged 40-59 years drawn at random from the age-sex registers of one general practice in each town. MAIN OUTCOME MEASURES--Major ischaemic heart disease events such as sudden cardiac death, other deaths attributed to ischaemic heart disease, and non-fatal myocardial infarction. RESULTS--During the follow up period of eight years, 488 men had a major ischaemic heart disease event (217 fatal and 271 non-fatal). Of these, 117 were classified as sudden cardiac death (death within one hour of the start of symptoms). The relation between heart rate and risk of all major ischaemic heart disease events, ischaemic heart disease deaths, and sudden cardiac death was examined separately in men with and without pre-existing ischaemic heart disease. In men with no evidence of ischaemic heart disease, there was a strong positive association between resting heart rate and age adjusted rates of all major ischaemic heart disease events (fatal and non-fatal), ischaemic heart disease deaths, and sudden cardiac death. This association remained significant even after adjustment for age, systolic blood pressure, blood cholesterol, smoking, social class, heavy drinking, and physical activity, with particularly high risk in those with heart rate > or = 90 beats/min. The increased risk seen in those with increased heart rate was largely due to a significantly increased risk of sudden cardiac death, which was five times higher than in those with heart rate < 60 beats/min. The effect of heart rate on sudden cardiac death was present irrespective of blood pressure or smoking state. In men with pre-existing ischaemic heart disease a positive association was seen between raised heart rate and risk of all major ischaemic heart disease events, ischaemic heart disease death, and sudden cardiac death, but the effect was less noticeable than in men without pre-existing ischaemic heart disease. CONCLUSION--In this study of middle aged British men increased heart rate > or = 90 beats/min) is a risk factor for fatal ischaemic heart disease events but particularly for sudden cardiac death. The effect is not dependent on the presence of other established coronary risk factors and is most clearly seen in men free of pre-existing ischaemic heart disease at initial examination.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Soliman, E. Z., Elsalam, M. A., Li, Y. (2009). The relationship between high resting heart rate and ventricular arrhythmogenesis in patients referred to ambulatory 24 h electrocardiographic recording. Europace 0: eup344v1-eup344 [Abstract] [Full Text]  
• Steg, P. G. (2009). Heart rate management in coronary artery disease: the CLARIFY registry. Eur Heart J Suppl 11: D13-D18 [Abstract] [Full Text]  
• Bangalore, S., Sawhney, S., Messerli, F. H. (2008). Relation of Beta-Blocker-Induced Heart Rate Lowering and Cardioprotection in Hypertension. J Am Coll Cardiol 52: 1482-1489 [Abstract] [Full Text]  
• Lahiri, M. K., Kannankeril, P. J., Goldberger, J. J. (2008). Assessment of Autonomic Function in Cardiovascular Disease: Physiological Basis and Prognostic Implications. J Am Coll Cardiol 51: 1725-1733 [Abstract] [Full Text]  
• Hall, A S, Palmer, S (2008). The heart rate hypothesis: ready to be tested. Heart 94: 561-565 [Abstract] [Full Text]  
• Savonen, K P, Lakka, T A, Laukkanen, J A, Rauramaa, T H, Salonen, J T, Rauramaa, R (2008). Workload at the heart rate of 100 beats/min and mortality in middle-aged men with known or suspected coronary heart disease. Heart 94: e14-e14 [Abstract] [Full Text]  
• Cucherat, M. (2007). Quantitative relationship between resting heart rate reduction and magnitude of clinical benefits in post-myocardial infarction: a meta-regression of randomized clinical trials. Eur Heart J 28: 3012-3019 [Abstract] [Full Text]  
• Authors/Task Force Members, , Graham, I., Atar, D., Borch-Johnsen, K., Boysen, G., Burell, G., Cifkova, R., Dallongeville, J., De Backer, G., Ebrahim, S., Gjelsvik, B., Herrmann-Lingen, C., Hoes, A., Humphries, S., Knapton, M., Perk, J., Priori, S. G., Pyorala, K., Reiner, Z., Ruilope, L., Sans-Menendez, S., Scholte op Reimer, W., Weissberg, P., Wood, D., Yarnell, J., Zamorano, J. L., Other experts who contributed to parts of the guid, , Walma, E., Fitzgerald, T., Cooney, M. T., Dudina, A., European Society of Cardiology (ESC) Committee for, , Vahanian, A., Camm, J., De Caterina, R., Dean, V., Dickstein, K., Funck-Brentano, C., Filippatos, G., Hellemans, I., Kristensen, S. D., McGregor, K., Sechtem, U., Silber, S., Tendera, M., Widimsky, P., Zamorano, J. L., Document reviewers:, , Hellemans, I., Altiner, A., Bonora, E., Durrington, P. N., Fagard, R., Giampaoli, S., Hemingway, H., Hakansson, J., Kjeldsen, S. E., Larsen, M. L., Mancia, G., Manolis, A. J., Orth-Gomer, K., Pedersen, T., Rayner, M., Ryden, L., Sammut, M., Schneiderman, N., Stalenhoef, A. F., Tokgozoglu, L., Wiklund, O., Zampelas, A. (2007). European guidelines on cardiovascular disease prevention in clinical practice: executive summary: Fourth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (Constituted by representatives of nine societies and by invited experts). Eur Heart J 28: 2375-2414 [Full Text]  
• Hjalmarson, A. (2007). Heart rate: an independent risk factor in cardiovascular disease. Eur Heart J Suppl 9: F3-F7 [Abstract] [Full Text]  
• Paterson, A. D., Rutledge, B. N., Cleary, P. A., Lachin, J. M., Crow, R. S., for the Diabetes Control and Complications Trial/E, (2007). The Effect of Intensive Diabetes Treatment on Resting Heart Rate in Type 1 Diabetes: The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study. Diabetes Care 30: 2107-2112 [Abstract] [Full Text]  
• Cook, S., Togni, M., Schaub, M. C., Wenaweser, P., Hess, O. M. (2006). High heart rate: a cardiovascular risk factor?. Eur Heart J 27: 2387-2393 [Full Text]  
• Mozaffarian, D., Prineas, R. J., Stein, P. K., Siscovick, D. S. (2006). Dietary Fish and n-3 Fatty Acid Intake and Cardiac Electrocardiographic Parameters in Humans. J Am Coll Cardiol 48: 478-484 [Abstract] [Full Text]  
• Savonen, K. P., Lakka, T. A., Laukkanen, J. A., Halonen, P. M., Rauramaa, T. H., Salonen, J. T., Rauramaa, R. (2006). Heart rate response during exercise test and cardiovascular mortality in middle-aged men. Eur Heart J 27: 582-588 [Abstract] [Full Text]  
• Mozaffarian, D., Geelen, A., Brouwer, I. A., Geleijnse, J. M., Zock, P. L., Katan, M. B. (2005). Effect of Fish Oil on Heart Rate in Humans: A Meta-Analysis of Randomized Controlled Trials. Circulation 112: 1945-1952 [Abstract] [Full Text]  
• Tendera, M. (2005). Editorial: If inhibition: from pure heart reduction to treatment of stable angina. Eur Heart J Suppl 7: H3-H6 [Full Text]  
• Hemingway, H., Shipley, M., Brunner, E., Britton, A., Malik, M., Marmot, M. (2005). Does Autonomic Function Link Social Position to Coronary Risk?: The Whitehall II Study. Circulation 111: 3071-3077 [Abstract] [Full Text]  
• Geelen, A., Brouwer, I. A, Schouten, E. G, Maan, A. C, Katan, M. B, Zock, P. L (2005). Effects of n-3 fatty acids from fish on premature ventricular complexes and heart rate in humans. Am. J. Clin. Nutr. 81: 416-420 [Abstract] [Full Text]  
• Dallongeville, J., Yarnell, J., Ducimetiere, P., Arveiler, D., Ferrieres, J., Montaye, M., Luc, G., Evans, A., Bingham, A., Hass, B., Ruidavets, J.-B., Amouyel, P. (2003). Fish Consumption Is Associated With Lower Heart Rates. Circulation 108: 820-825 [Abstract] [Full Text]  
• Lawlor, D A, Taylor, M, Bedford, C, Ebrahim, S (2002). Is housework good for health? Levels of physical activity and factors associated with activity in elderly women. Results from the British Women's Heart and Health Study. J. Epidemiol. Community Health 56: 473-478 [Abstract] [Full Text]  
• Priori, S. G., Aliot, E., Blomstrom-Lundqvist, C., Bossaert, L., Breithardt, G., Brugada, P., Camm, J. A., Cappato, R., Cobbe, S. M., Di Mario, C., Maron, B. J., McKenna, W. J., Pedersen, A. K., Ravens, U., Schwartz, P. J., Trusz-Gluza, M., Vardas, P., Wellens, H. J. J., Zipes, D. P. (2002). TASK FORCE ON SUDDEN CARDIAC DEATH, EUROPEAN SOCIETY OF CARDIOLOGY: Summary of Recommendations. Europace 4: 3-18 [Abstract]  
• Singh, B. N. (2001). Morbidity and Mortality in Cardiovascular Disorders: Impact of Reduced Heart Rate. J CARDIOVASC PHARMACOL THER 6: 313-331  
• Ray, W. A., Meredith, S., Thapa, P. B., Meador, K. G., Hall, K., Murray, K. T. (2001). Antipsychotics and the Risk of Sudden Cardiac Death. Arch Gen Psychiatry 58: 1161-1167 [Abstract] [Full Text]  
• Priori, S.G., Aliot, E., Blomstrom-Lundqvist, C., Bossaert, L., Breithardt, G., Brugada, P., Camm, A.J., Cappato, R., Cobbe, S.M., Di Mario, C., Maron, B.J., McKenna, W.J., Pedersen, A.K., Ravens, U., Schwartz, P.J., Trusz-Gluza, M., Vardas, P., Wellens, H.J.J., Zipes, D.P. (2001). Task Force on Sudden Cardiac Death of the European Society of Cardiology. Eur Heart J 22: 1374-1450  
• Jouven, X., Zureik, M., Desnos, M., Guerot, C., Ducimetiere, P. (2001). Resting heart rate as a predictive risk factor for sudden death in middle-aged men. Cardiovasc Res 50: 373-378 [Abstract] [Full Text]  
• Wannamethee, S. G., Shaper, A. G., Alberti, K. G. M. M. (2000). Physical Activity, Metabolic Factors, and the Incidence of Coronary Heart Disease and Type 2 Diabetes. Arch Intern Med 160: 2108-2116 [Abstract] [Full Text]  
• GROTE, L., PLOCH, T., HEITMANN, J., KNAACK, L., PENZEL, T., PETER, J. H. (1999). Sleep-related Breathing Disorder Is an Independent Risk Factor for Systemic Hypertension. Am. J. Respir. Crit. Care Med. 160: 1875-1882 [Abstract] [Full Text]  
• Laperche, T, Logeart, D, Cohen-Solal, A, Gourgon, R (1999). Potential interests of heart rate lowering drugs. Heart 81: 336-341 [Full Text]  
• BRUNEKREEF, B. (1999). All But Quiet on the Particulate Front. Am. J. Respir. Crit. Care Med. 159: 354-356 [Full Text]  
• Shaper, A G., Wannamethee, S G., Walker, M. (1997). Body weight: implications for the prevention of coronary heart disease, stroke, and diabetes mellitus in a cohort study of middle aged men. BMJ 314: 1311-1311 [Abstract] [Full Text]  
• Wannamethee, G., Shaper, A. G., Macfarlane, P. W., Walker, M. (1995). Risk Factors for Sudden Cardiac Death in Middle-Aged British Men. Circulation 91: 1749-1756 [Abstract] [Full Text]