Resting heart rate and incident heart failure and cardiovascular mortality in older adults: role of inflammation and endothelial dysfunction: the PROSPER study

Aims Resting heart rate is a promising modifiable cardiovascular risk marker in older adults, but the mechanisms linking heart rate to cardiovascular disease are not fully understood. We aimed to assess the association between resting heart rate and incident heart failure (HF) and cardiovascular mortality, and to examine whether these associations might be attributable to systemic inflammation and endothelial dysfunction. Methods and results We studied 4084 older adults aged 70–82 years with known cardiovascular risk factors or previous cardiovascular disease, without pre‐existing HF or beta‐blockers in the PROSPER study. Over a 3.2‐year follow‐up period, we examined incident HF hospitalization and cardiovascular mortality according to resting heart rate, along with C‐reactive protein (CRP), interleukin‐6 (IL‐6), tissue plasminogen activator (tPA), and von Willebrand factor (vWf). Mean heart rate was 67 b.p.m. for men and 70 b.p.m. for women. CRP, IL‐6, tPA, and vWf levels were all positively correlated with heart rate. After multivariate adjustment, heart rate was associated with HF hospitalization [hazard ratio (HR) 1.78 for highest vs. lowest distribution third, 95% confidence interval (CI) 1.21–2.63, P = 0.003] and cardiovascular mortality (HR 1.74, 95% CI 1.23–2.47, P = 0.002). Further adjustment for both IL‐6 and vWf levels decreased HR to 1.60 (95% CI 1.08–2.38, P = 0.020) for HF and to 1.50 (95% CI 1.04–2.15, P = 0.028) for cardiovascular mortality. Conclusion Increased heart rate is associated with increased systemic inflammation and endothelial dysfunction. These factors are likely to contribute to, but do not fully explain, the risk of HF and cardiovascular death associated with increased heart rate in older age.