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Nutr Metab Cardiovasc Dis. 2017 Jun;27(6):504-517. doi: 10.1016/j.numecd.2017.04.004. Epub 2017 Apr 21.

Resting heart rate and the risk of cardiovascular disease, total cancer, and all-cause mortality - A systematic review and dose-response meta-analysis of prospective studies.

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Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Department of Epidemiology and Public Health, Imperial College, London, UK; Bjørknes University College, Oslo, Norway. Electronic address:
Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
Department of Radiology, Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, USA; Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, Adler Geriatric Center, New Haven, USA.
Department of Preventive Cardiology, Oslo University Hospital Ullevål, Oslo, Norway.



Epidemiological studies have reported increased risk of cardiovascular disease, cancer and all-cause mortality with greater resting heart rate, however, the evidence is not consistent. Differences by gender, adjustment for confounding factors, as well as the potential impact of subclinical disease are not clear. A previous meta-analysis missed a large number of studies, and data for atrial fibrillation have not been summarized before. We therefore aimed to clarify these associations in a systematic review and meta-analysis of prospective studies.


PubMed and Embase were searched up to 29 March 2017. Summary RRs and 95% confidence intervals (CIs) were calculated using random effects models. Eighty seven studies were included. The summary RR per 10 beats per minute increase in resting heart rate was 1.07 (95% CI: 1.05-1.10, I2 = 61.9%, n = 31) for coronary heart disease, 1.09 (95% CI: 1.00-1.18, I2 = 62.3%, n = 5) for sudden cardiac death, 1.18 (95% CI: 1.10-1.27, I2 = 74.5%, n = 8) for heart failure, 0.97 (95% CI: 0.92-1.02, I2 = 91.4%, n = 9) for atrial fibrillation, 1.06 (95% CI: 1.02-1.10, I2 = 59.5%, n = 16) for total stroke, 1.15 (95% CI: 1.11-1.18, I2 = 84.3%, n = 35) for cardiovascular disease, 1.14 (95% CI: 1.06-1.23, I2 = 90.2%, n = 12) for total cancer, and 1.17 (95% CI: 1.14-1.19, I2 = 94.0%, n = 48) for all-cause mortality. There was a positive dose-response relationship for all outcomes except for atrial fibrillation for which there was a J-shaped association.


This meta-analysis found an increased risk of coronary heart disease, sudden cardiac death, heart failure, atrial fibrillation, stroke, cardiovascular disease, total cancer and all-cause mortality with greater resting heart rate.


All-cause mortality; Atrial fibrillation; Cancer; Cardiovascular disease; Coronary heart disease; Heart failure; Stroke; Sudden cardiac death

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