I found this gem today. :-( I used to have a nice, low resting HR before surgery. Since then, it's high 70's. After a few hours of vigorous exercise, I stay north of 100 bpm for an hour or more. No indication in the article of a causal relationship (as opposed to correlation), but kind of disturbing.
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Sudden Death in Healthy Men Can Be Predicted by Heart Rate
By Peggy Peck, Senior Editor, MedPage Today
Reviewed by Rubeen K. Israni, M.D., Fellow, Renal-Electrolyte and Hypertension Division, University of Pennsylvania School of Medicine
May 11, 2005
Also covered by: MSN, MSNBC, WSJ Online (Subscription Req.)
MedPage Today Action Points
This research suggests a role for routine exercise testing of asymptomatic men to determine heart rate at rest, during exercise and during recovery.
Current ACC/AHA guidelines recommend: On the basis of prognostic considerations, asymptomatic male patients older than 45 years with 1 or more risk factors (hypercholesterolemia, hypertension, smoking, diabetes, or family history of premature CAD) may obtain useful prognostic information from exercise testing. The greater the number of risk factors (ie, pretest probability), the more likely the patient will profit from screening.
Review
PARIS, May 11-Even in this city in the springtime, a Frenchman's heart that beats too fast at rest is a powerful predictor of sudden death, researchers here have reported.
A study of 5,713 French men without known or suspected cardiovascular disease found that those with resting heart rates of more than 75 beats per minute had a 3.5-fold increase in risk of sudden death compared with men who had a resting heart rate of fewer than 60 beats per minute.
And men who had a less than optimum increase in heart rate during exercise had 4.0 times the risk of sudden death, 1.2 times the risk of nonsudden death, and 1.5 times the risk of death from any cause, Xavier Jouven, M.D., Ph.D., and colleagues of the University of Paris reported in Thursday's New England Journal of Medicine.
Moreover, men who take longer to recover from exercise, specifically those whose heart rate recovery is fewer than 25 beats per minute, had 2.1 times the risk of sudden death than men whose hearts recover at a rate of 40 beats per minute.
The increased risks were independent of other risk factors including age, smoking history, level of physical activity, exercise duration during standard bicycle exercise test, history of diabetes, body mass index, systolic blood pressure, cholesterol level, and parental history of sudden death or myocardial infarction.
Noting that the heart-response is controlled by the autonomic nervous system, Dr. Jouven said the "data support the concept that abnormalities in autonomic balance may precede manifestations of cardiovascular disease and may contribute to the early identification of persons at high risk for sudden death."
For apparently healthy men who have similar abnormal heart rate profiles, "a possible therapeutic approach might be the correction of the autonomic imbalance. In addition to traditional management of cardiovascular risk factors, initiation of a regular exercise-training program should be recommended," Dr. Jouven and colleagues wrote.
The findings come from the Paris Prospective Study I, which recruited men employed by the Paris Civil Service. Recruitment was conducted from 1967 to 1972 when the men were ages 42 to 53. The study enrolled 7,746 men, and the vital status of all but 355 subjects (4.6% from the original 7,746) could be determined at the end of study follow-up in January 1994. This latest analysis includes data on 5,713 men, all of whom underwent electrocardiographic and physical examinations at baseline.
All men underwent a standard 10-minute bicycle exercise test with three successive workloads -- two minutes at 82 W, six minutes at 164 W, and the last two minutes at 191 W, with no cool-down period. Cardiac rhythm was continuously monitored during testing.
Heart rate was measured at rest, before exercise, every two minutes during exercise, at peak exercise and every minute during recovery. Men who had an ischemic changes on EKG and those who failed to achieve 80% of predicted maximum heart rate during exercise (defined as 220 beats per minute minus age) were excluded from the analysis. The mean follow-up was 23 years.
Among the findings:
There were 1,516 deaths during follow-up including 400 cardiac deaths of which 81 were sudden deaths and 129 were nonsudden deaths from myocardial infarction.
Men in the highest quintile for resting heart rate (>75 beats a minute) had a risk for sudden death (relative risk, 3.92; 95% confidence interval 1.91-8.0) that was 3.5 times higher than men in the lowest quintile for resting heart rate (<60 beats a minute) (P for trend <0.001).
Compared with the highest quintile (113 beats per minute) men with a heart rate increase of fewer than 89 beats per minute during exercise (relative risk, 6.18; 95% confidence interval, 1.02 to 4.74) had 4.0 times the risk of sudden death.
The authors concluded that the "heart rate profile during exercise and recovery is a powerful predictor of the risk of sudden death in asymptomatic men?These findings may have clinical implications in terms of early identification of high-risk subjects and raise the possibility of primary prevention."
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