Ho, Jennifer E.Larson, Martin G.Ghorbani, AnahitaCheng, SusanCoglianese, Erin E.Vasan, Ramachandran S.Wang, Thomas J.2015-02-022014Ho, Jennifer E., Martin G. Larson, Anahita Ghorbani, Susan Cheng, Erin E. Coglianese, Ramachandran S. Vasan, and Thomas J. Wang. 2014. “Long‐term Cardiovascular Risks Associated With an Elevated Heart Rate: The Framingham Heart Study.” Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease 3 (3): e000668. doi:10.1161/JAHA.113.000668. http://dx.doi.org/10.1161/JAHA.113.000668.2047-9980http://nrs.harvard.edu/urn-3:HUL.InstRepos:13890747Background: Higher heart rate has been associated with an adverse prognosis, but most prior studies focused on individuals with known cardiovascular disease or examined a limited number of outcomes. We sought to examine the association of baseline heart rate with both fatal and nonfatal outcomes during 2 decades of follow‐up. Methods and Results: Our study included 4058 Framingham Heart Study participants (mean age 55 years, 56% women). Cox models were performed with multivariable adjustment for clinical risk factors and physical activity. A total of 708 participants developed incident cardiovascular disease (303 heart failure, 343 coronary heart disease, and 216 stroke events), 48 received a permanent pacemaker, and 1186 died. Baseline heart rate was associated with incident cardiovascular disease (hazard ratio [HR] 1.15 per 1 SD [11 bpm] increase in heart rate, 95% CI 1.07 to 1.24, P=0.0002), particularly heart failure (HR 1.32, 95% CI 1.18 to 1.48, P<0.0001). Higher heart rate was also associated with higher all‐cause (HR 1.17, 95% CI 1.11 to 1.24, P<0.0001) and cardiovascular mortality (HR 1.18, 95% CI 1.04 to 1.33, P=0.01). Spline analyses did not suggest a lower threshold beyond which the benefit of a lower heart rate abated or increased. In contrast, individuals with a higher heart rate had a lower risk of requiring permanent pacemaker placement (HR 0.55, 95% CI 0.38 to 0.79, P=0.001). Conclusions: Individuals with a higher heart rate are at elevated long‐term risk for cardiovascular events, in particular, heart failure, and all‐cause death. On the other hand, a higher heart rate is associated with a lower risk of future permanent pacemaker implantation.en-USEpidemiologycardiovascular diseaseepidemiologyheart failurerisk factorJournal Article2015-02-0210.1161/JAHA.113.000668