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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

Resting Heart Rate as a Low Tech Predictor of Coronary Events in Women – Comment

We read with interest the recently published article Resting Heart
Rate as Low Tech Predictor of Coronary Events in Women: Prospective Cohort
Study, by Hsia and colleagues, regarding the predictive value of resting
heart rate in women.. The association between higher heart rate and
increased prevalence of coronary events was stronger for the younger
cohort than the older cohort.

We previously studied the relationship between resting heart rate and
mortality in an elderly population from the Jerusalem 70-year-old cohort.
We have shown that in this population, resting heart rate (as measured
both by pulse counting as well by electrocardiograms) was an independent
predictor of mortality among women aged 70 years, who were followed for 6
years (ROR for death 3.71, 95% CI 1.41-9.8). This association was
independent of previous cardiovascular or cerebrocascular disease,
congestive heart failure, anemia, and other risk factors including
hypertension, smoking, and level of exercise or activities of daily
living. When women treated with beta blockers were excluded, this
relationship became even stronger (ROR for death 8.86, 95% CI 2.17-36.23).
We found a very good correlation between palpated pulse rate and
electrocardiographic hear rate (correlation coefficient 0.79, p=0.0001).
The relationships between heart rate and mortality were similar whether
the palpated pulse or the electrocardiographic one were employed. Of note,
in our data we controlled for the presence of anemia, which may be more
prevalent among the elderly, and may have been a confounder in Hsia’s

Prior studies have also demonstrated that increasing heart rate may
be related to increased cardiovascular mortality in different age groups,
both in men and in women (3,4). With these in mind, our data, and the
current paper by Hsia and colleagues, we join the authors in their
conclusion that heart rate may be an independent, “low tech” low cost
indicator of general health. In this age of increasing costs for
sophisticated risk-stratification tools, it seems that such a simple
measure of general health status should be welcomed, and efforts should be
directed at understanding how to use this information for improved health

1.Hsia J, Larson JC, Ockene JK, Sarto GE, Allison MA, Hendrix SL, Robinson
JG, LaCroix AZ, Manson JE; Women's Health Initiative Research Group.
Resting heart rate as a low tech predictor of coronary events in women:
prospective cohort study. BMJ. 2009 Feb 3;338:b219.

2.Perk G, Stessman J, Ginsberg G, Bursztyn M. Sex differences in the
effect of heart rate on mortality in the elderly. J Am Geriatr Soc. 2003

3.Palatini P, Casiglia E, Julius S, Pessina AC. High heart rate: a risk
factor for cardiovascular death in elderly men. Arch Intern Med. 1999 Mar

4.Greenland P, Daviglus ML, Dyer AR, Liu K, Huang CF, Goldberger JJ,
Stamler J. Resting heart rate is a risk factor for cardiovascular and
noncardiovascular mortality: the Chicago Heart Association Detection
Project in Industry. Am J Epidemiol. 1999 May 1;149(9):853-62.

Competing interests:
None declared

Competing interests: No competing interests

11 February 2009
Gila Perk
Faculty, Department of Cardiology
Michael Bursztyn