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Resting heart rate as a low tech predictor of coronary events in women: prospective cohort study

BMJ 2009; 338 doi: (Published 04 February 2009) Cite this as: BMJ 2009;338:b219
  1. Judith Hsia, professor 1,
  2. Joseph C Larson, statistician 2,
  3. Judith K Ockene, professor3,
  4. Gloria E Sarto, professor4,
  5. Matthew A Allison, assistant professor5,
  6. Susan L Hendrix, physician6,
  7. Jennifer G Robinson, associate professor7,
  8. Andrea Z LaCroix, professor2,
  9. JoAnn E Manson, professor8,
  10. for the Women’s Health Initiative Research Group
  1. 1George Washington University, Washington, DC 20037
  2. 2Fred Hutchinson Cancer Research Center, Seattle, WA 98109
  3. 3University of Massachusetts, Worcester, MA 01655
  4. 4University of Wisconsin, Madison, WI 53715
  5. 5University of California San Diego, La Jolla, CA 92093
  6. 6Detroit Medical Center, Detroit, MI 48201
  7. 7University of Iowa, Iowa City, IA 52242
  8. 8Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02215
  1. Correspondence to: J Hsia, AstraZeneca LP, Wilmington, DE 19850 judith.hsia{at}
  • Accepted 1 November 2008


Objective To evaluate resting heart rate as an independent predictor of cardiovascular risk in women.

Design Prospective cohort study.

Setting The Women’s Health Initiative was undertaken at 40 research clinics in the United States.

Participants 129 135 postmenopausal women.

Main outcome measure Clinical cardiovascular events.

Results During a mean of 7.8 (SD 1.6) years of follow up, 2281 women were identified with myocardial infarction or coronary death and 1877 with stroke. We evaluated associations between resting heart rate and cardiovascular events in Cox regression models adjusted for multiple covariates. Higher resting heart rate was independently associated with coronary events (hazard ratio 1.26, 95% confidence interval 1.11 to 1.42 for highest [>76 beats per minute] v lowest quintile [≤62 beats per minute]; P=0.001), but not with stroke. The relation between heart rate and coronary events did not differ between white women and women from other ethnic groups (P for interaction=0.45) or between women with and without diabetes (P for interaction=0.31), but it was stronger in women aged 50-64 at baseline than in those aged 65-79 (P for interaction=0.009).

Conclusion Resting heart rate, a low tech and inexpensive measure of autonomic tone, independently predicts myocardial infarction or coronary death, but not stroke, in women.

Trial registration NCT00000611.


  • Women’s Health Initiative investigators are listed at

  • Contributors: JH was responsible for conception and design of this analysis and drafted the manuscript. JCL analysed and interpreted the data, JKO, GES, MAA, SLH, JGR, AZL, JEM interpreted the data and critically reviewed the manuscript. The final version was approved by all authors. JH is the guarantor.

  • Funding: The Women’s Health Initiative programme is funded by the National Heart, Lung and Blood Institute, National Institutes of Health, US Department of Health and Human Services through contracts N01WH22110, 24152, 32100-2, 32105-6, 32108-9, 32111-13, 32115, 32118-32119, 32122, 42107-26, 42129-32, and 44221. The sponsor had no role in performing this analysis or the decision to proceed to publication; representatives of the sponsor did participate in the study design.

  • Competing interests: None declared.

  • Ethical approval: The protocol and consent forms were approved by institutional review boards of the participating institutions; all trial participants provided written informed consent.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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