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Heritability of resting heart rate and association with mortality in middle-aged and elderly twins
  1. Patricia B Munroe1,2,
  2. Andrew Tinker1,2
  1. 1Department of Clinical Pharmacology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
  2. 2NIHR Barts Cardiovascular Biomedical Research Centre, Queen Mary University of London, London, UK
  1. Correspondence to Professor Patricia B Munroe, Department of Clinical Pharmacology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London Charterhouse Square, London EC1M 6BQ, UK; p.b.munroe{at}qmul.ac.uk

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Resting heart rate (RHR) is a well-recognised risk factor for cardiovascular morbidity and mortality.1 An increase of 20 beats per minute (bpm) in RHR leads to a 30%–50% excess mortality that is independent of confounding factors.2 This association of increased RHR with higher mortality rates has been shown in a number of epidemiological studies. For example, in Paris Prospective Study I, the risk of sudden death increased over threefold (relative risk 3.9) in individuals with an RHR >75 bpm compared with those with one under 60 bpm.3 Also, heart rate has moderate genetic influences, with heritable factors from twin studies accounting for up to 65% of the variation. A large-scale genetic study has indicated that the heritability of RHR using directly genotyped genetic variants is 21.2%,4 and identified >70 genetic loci explaining <3% of the variance in RHR. The authors also reported that a genetically determined RHR increase of 5 bpm was associated with a 20% increase in mortality risk.4

In this issue, Jensen and colleagues report the heritability of RHR in 4282 twins (aged 45 years and older), and demonstrate a significant association of RHR with all-cause mortality and cardiovascular mortality. This was extended to observations within twin pairs, where the twin with …

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