Heart 99:882-887 doi:10.1136/heartjnl-2012-303375
  • Epidemiology
  • Original article

Elevated resting heart rate, physical fitness and all-cause mortality: a 16-year follow-up in the Copenhagen Male Study

Open Access
  1. Finn Gyntelberg2
  1. 1Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark
  2. 2Copenhagen Male Study, Epidemiologic Research Unit, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
  3. 3Research Centre for Prevention and Health, Copenhagen University Hospital Glostrup, Copenhagen, Denmark
  1. Correspondence to Dr Magnus Thorsten Jensen, Department of Cardiology, Copenhagen University Hospital Gentofte, Niels Andersens Vej 65, 2900 Hellerup, Denmark; magnustjensen{at}
  • Received 14 November 2012
  • Revised 29 January 2013
  • Accepted 5 March 2013
  • Published Online First 17 April 2013


Objective To examine whether elevated resting heart rate (RHR) is an independent risk factor for mortality or a mere marker of physical fitness (VO2Max).

Methods This was a prospective cohort study: the Copenhagen Male Study, a longitudinal study of healthy middle-aged employed men. Subjects with sinus rhythm and without known cardiovascular disease or diabetes were included. RHR was assessed from a resting ECG at study visit in 1985–1986. VO2Max was determined by the Åstrand bicycle ergometer test in 1970–1971. Subjects were classified into categories according to level of RHR. Associations with mortality were studied in multivariate Cox models adjusted for physical fitness, leisure-time physical activity and conventional cardiovascular risk factors.

Results 2798 subjects were followed for 16 years. 1082 deaths occurred. RHR was inversely related to physical fitness (p<0.001). Overall, increasing RHR was highly associated with mortality in a graded manner after adjusting for physical fitness, leisure-time physical activity and other cardiovascular risk factors. Compared to men with RHR ≤50, those with RHR >90 had an HR (95% CI) of 3.06 (1.97 to 4.75). With RHR as a continuous variable, risk of mortality increased with 16% (10–22) per 10 beats per minute (bpm). There was a borderline interaction with smoking (p=0.07); risk per 10 bpm increase in RHR was 20% (12–27) in smokers, and 14% (4–24) in non-smokers.

Conclusions Elevated RHR is a risk factor for mortality independent of physical fitness, leisure-time physical activity and other major cardiovascular risk factors.

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