Cardiovascular Disease and All-Cause Mortality Not Linked to Heart Rate Variability

The investigators studied associations between 5-year changes in rHR and HRV and risk of future CVD and death, taking into account participants’ baseline glycemic state.

Neither resting heart rate (rHR) nor heart rate variability (HRV) among patients with or without dysglycemia were predictors of cardiovascular disease (CVD) or mortality. These findings from a prospective, population-based cohort study were published in Diabetes Care.

British civil servants (N=10,308) were recruited to participate in the Whitehall II study in 1985. Every 5 years, participants were assessed by electrocardiogram and for glycemic status. This study analyzed data from the phase 7 (2002-2004) follow-up, which included 4611 total participants.

Of the study population, 70.2% were men and 93.0% were White. They had a mean (standard deviation or SD) age of 60.5 (5.9) years, an average body mass index (BMI) of 26.4 (4.2) kg/m2, and rHR of 68.0 (11.4) beats per minute (bpm).

Most participants (63.3%) were normoglycemic, 29.1% had prediabetes, 5.8% had established diabetes, and 1.8% had diabetes diagnosed at study follow-up.

A total of 47 fatal and 251 nonfatal CVD events occurred among participants. Non-CVD-related mortality events occurred among 279 individuals.

Resting heart rate (per 10 bpm) did not associate significantly with CVD (rate ratio [RR], 1.10; 95% CI, 0.96-1.25; P =.166) or all-cause mortality (RR, 1.01; 95% CI, 0.90-1.14; P =.864). Significant associations were not observed between CVD or all-cause mortality with SD of N-N R-R intervals, root mean square of the sum of the squares of differences between N-N R-R intervals, low frequency power, high frequency power, low/high frequency ratio, or total power (all P ³.076).

No modifying effect was observed for glycemic status with any rHR or HRV assessments (P ³.298).

The change in rHR and HRV over 5 years were not associated with CVD or all-cause mortality (all P >.05).

This study was limited by its participants being primarily White men who were civil servants with a higher level of physical activity and a lower prevalence of smoking than in the general populations. Future studies should include a more varied group of participants so study results can be generalized to a diverse population.

The study authors concluded that regardless of glycemic control, rHR and HRV over 5 years were not significant predictors of CVD or all-cause mortality.


Hansen CS, Jørgensen ME, Malik M, et al. Heart rate and heart rate variability changes are not related to future cardiovascular disease and death in people with and without dysglycemia: a downfall of risk markers? The Whitehall II Cohort Study. Diabetes Care. Published online February 1, 2021. doi:10.2337/dc20-2490