Resting heart rate and incident venous thromboembolism: the Multi-Ethnic Study of Atherosclerosis

• Type of Material: Article
• Authors: Josephine Awotoye, University of Minnesota; Oluwaseun E Fashanu, Saint Agnes Hospital, Baltimore; Pamela L Lutsey, University of Minnesota; Di Zhao, Johns Hopkins Bloomberg School of Public Health; Wesley T O'Neal, Emory University; Erin D Michos, Johns Hopkins School of Medicine
• Language: English
• Date: 2020-02-20
• Publisher: BMJ Publishing Group
• Publication Version: Final Published Version
• Copyright Statement: © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1136/openhrt-2019-001080
• Title of Journal or Parent Work: Open Heart
• Volume: 7
• Issue: 1
• Grant/Funding Information: EDM and DZ were supported by the Blumenthal Scholars Fund for Preventive Cardiology Research at Johns Hopkins University. This MESA study was supported by contracts HHSN268201500003I, N01-HC-95159, N01-HC-95160, N01-HC-95161, N01-HC-95162, N01-HC-95163, N01-HC-95164, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168 and N01-HC-95169 from the National Heart, Lung and Blood Institute (NHLBI), and by grants UL1-TR-000040, UL1-TR-001079 and UL1-TR-001420 from NCATS.
• Keywords: epidemiology; heart rate variability; venous thromboembol; deep vein thrombosis
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Epidemiology

Abstract

Objective Venous thromboembolism (VTE) is associated with significant morbidity and mortality. Resting heart rate (RHR), which may be modifiable through lifestyle changes, has been shown to be associated with cardiovascular disease risk and with inflammatory markers that have been predictive of VTE incidence. Methods We examined whether RHR is also associated with VTE incidence independent of these risk factors. We studied 6479 Multi-Ethnic Study of Atherosclerosis participants free from clinical VTE at baseline who had baseline RHR ascertained by 12-lead ECG. VTE events were recorded from hospital records and death certificates using International Classification of Diseases (ICD)-9 and ICD-10 codes. We categorised RHR as <60, 60–69, 70–79 and ≥80 bpm. We used Cox hazard models to determine the association of incident VTE by RHR. Results Participants had mean (SD) age of 62 (10) years and RHR of 63 (10) bpm. RHR was cross-sectionally correlated with multiple inflammatory and coagulation factors. There were 236 VTE cases after a median follow-up of 14 years. Compared with those with RHR<60 bpm, the HR (95% CI) for incident VTE for RHR≥80 bpm was 2.08 (1.31 to 3.30), after adjusting for demographics, physical activity, smoking, diabetes and use of atrioventricular (AV)-nodal blockers, aspirin and anticoagulants, and remained significant after further adjustment for inflammatory markers (2.05 (1.29 to 3.26)). Results were similar after excluding those taking AV-nodal blocker medications. There was no effect modification of these associations by sex or age. Conclusion Elevated RHR was positively associated with VTE incidence after a median of 14 years; this association was independent of several traditional VTE and inflammatory markers.