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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 …
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