A trip to the doctor’s office for an annual physical typically yields a wealth of diagnostic data that helps paint a picture of our overall health. Blood work results show us our cholesterol, blood glucose and triglyceride levels. Urine analysis reveals information regarding our immunity and kidney function. Blood pressure measurements give us insight regarding our cardiovascular function.
Sometimes it’s downright confusing to figure out what to make of it all. Some readings seem good, others show a need for improvement, and yet others seem like just a bunch of random numbers on a page. Unless the doctor sternly delivers potentially bad news, we’re often left to wonder how good of shape we’re really in.
And yet, believe it or not, we have the most powerful diagnostic tool in our own hands. It doesn’t require heavy machinery, needles or centrifuges. It doesn’t involve peeing in a cup or need to be sent away for several days of lab work.
So what is this magical diagnostic measure that reveals all manner of insight into our overall health? Three words: resting heart rate. That’s right, sit down and relax for 10 minutes or so, then put your fingers on your wrist where you can feel your heart pulse, or against the carotid artery in your neck, look at a watch or nearby clock, and count the number of beats your heart registers in a 60-second span and, voila, you’re done.
If you want to get fancy about it, buy a pulse rate monitor or a device known as a pulse oximeter. These devices utilize sensors that detect either the electrical or light pulses associated with our heart rates and can provide information about your heart rate in a few seconds versus 60 seconds.
Now it may seem almost too simple to provide meaningful information, but there have been dozens of studies conducted over the past 10 years that reveal the diagnostic value of resting heart rate as a predictor of all-cause mortality and cardiovascular disease risk. These studies have evaluated resting heart rate in healthy middle-aged adults, the elderly, smokers, diabetics, people with heart disease and other population samples. All of them — that’s right, all of them — have demonstrated that resting heart rate is a significant predictor of all-cause mortality, and many of them have found similar predictive value when it comes to cardiovascular disease risk.
What’s more, a number of these studies have shown that resting heart rate is a BETTER predictor of all-cause mortality compared to all the other fancy tests our doctors run during a routine physical!
So let’s review a sampling of recent studies that illustrate the above points.
In a 2011 study published in the European Journal of Cardiovascular Prevention and Rehabilitation, a research team examined the medical records of 7,147 French citizens with an average age of 74 who participated in a larger health study. These subjects had their baseline resting heart rate taken twice at the outset of the study (subjects were asked to rest in a seated position for five minutes before each reading). Two years and four years later, the subjects returned to have their resting heart rate measured. Along with resting heart rate, the researchers collected blood, urine, blood pressure readings and medical history questionnaires at each visit. At an average of five years after the outset of the study, family physicians of the study participants were queried to determine if the participants were alive or dead. The researchers collected and analyzed all this data and arrived at some amazing conclusions:
- Study participants with higher RHR [Resting Heart Rate] (>79 beats per minute) had an 85 percent increased risk of cardiovascular and non-cardiovascular mortality compared to those with lower RHR (<62 beats per minute).
- The odds ratio of all-cause mortality rose 22 percent with each increase of 10.6 beats per minute in RHR.
- These results were the same regardless of any other risk factor evaluated in the study including age, hypertension, diabetes, prevalent cardiovascular disease, cancer or disability.
Some might say that these results don’t apply to younger people because the average age of the study participants was 74. For such skeptics, we offer the following insights by the same research team in a 2005 study published in the New England Journal of Medicine. In that study, 5,713 French men aged 42-53 were originally enrolled between 1967 and 1972. They were followed until 1994, at which time the research team compared deaths in the population against baseline resting heart rate measures taken at enrollment along with other diagnostic data.
The research team found that all-cause mortality was lowest in the men with baseline resting heart rate of less than 60 beats per minute. For men with a RHR greater than 75 beats per minute, the relative risk of all-cause mortality was nearly 100 percent higher. Even among men with RHR between 70 and 75 beats per minute, there was over 50 percent greater all-cause mortality risk.
And there are plenty of other tidbits of research results on the same topic from around the globe, so the point isn’t diminished based on populations in different geographic territories:
- A 1999 Chicag-based study followed 30,000 office workers for an average period of 22 years from study enrollment (between 1967 and 1973). Resting heart rate was collected at enrollment, and at the end of the follow-up period, deaths among the participants were assessed. The results showed that among 40-to-59-year-old adults, there was approximately 30 percent higher all-cause mortality risk associated with every 12 beats per minute increase in resting heart rate.
- A 2009 Chinese population study using 60-89 beats per minute as the control resting heart rate range found that participants with RHR less than 60 had a 13 percent to 24 percent lower risk of all-cause mortality, while participants with RHR greater than 90 had a 33 percent to 48 percent higher risk of all-cause mortality.
- A 2010 Danish population study among current, former and never smokers found that for every 10-beats-per-minute increase in resting heart rate, the risk of all-cause mortality rose 6 percent in never smokers, 11 percent in former smokers, and 13 percent in current smokers. The average difference in survival between study subjects in the lowest RHR range evaluated (less than 65 beats per minute) and the highest RHR range evaluated (more than 80 beats per minute) was 4.7 years in men and 3.6 years in women.
Honestly, we could go on for several thousand more words worth of study citations that illustrate the same point. Resting heart rate is a simple, non-invasive measure of one’s health status. Generally, RHR less than 65 is associated with significantly greater survival, while RHR in excess of 75 is associated with a significantly greater risk of mortality.
It’s Not Too Late
For those with resting heart rates in excess of 70-75 beats per minute, don’t freak out. It’s never too late.
There are several powerful ways to reduce resting heart rate notably over time that should be no surprise to our Peak Health Advocate subscribers as they are cornerstone elements of our healthy living philosophy (regular exercise, Mediterranean diet, sustained weight loss, permanent smoking cessation).
And a recent research study reported that middle-aged men who achieved at least a 4-beats-per-minute reduction in resting heart rate within a five-year period of their initial RHR reading reduced their all-cause mortality risk by 14 percent.
 Legeai C, et al. Resting heart rate, mortality and future coronary heart disease in the elderly: the 3C study. European Journal of Cardiovascular Prevention & Rehabilitation. 2011; 18(3): 488–497.
 Jouven X, et al. Heart-Rate Profile during Exercise as a Predictor of Sudden Death. N Engl J Med. 2005; 352: 1951-1958.
 Greenland P, et al. Resting Heart Rate is a Risk Factor for Cardiovascular and Noncardiovascular Mortality. American Journal of Epidemiology. 1999; 149(9): 853-862.
 Maj JZ, et al. Association between heart rate and all-cause death and coronary event in the Chinese cohort: 16 years follow up results. Zhonghua Xin Xue Guan Bing Za Zhi. 2009 Aug; 37(8): 750-753.
 Jensen MT, et al. Elevated resting heart rate is associated with greater risk of cardiovascular and all-cause mortality in current and former smokers. Int J Cardiol. 2010 June 2 (epub ahead of print).
 Jouven X, et al. Relation of heart rate at rest and long-term (>20 years) death rate in initially healthy middle-aged men. Am J Cardiol. 2009 Jan 15; 103(2): 279-283.