Abstract & Commentary
Synopsis: Older women with resting heart rates of 80 beats/min and above had increased rates of osteoporotic fractures and both cardiovascular mortality and all-cause mortality.
Source: Kado DM, et al. J Am Geriatr Soc. 2002;50:455-460.
As part of a large multicenter study on osteoporotic fractures in women aged 65 and older, nearly 10,000 women had measurements of supine pulse rate after resting 5 minutes in a quiet room. They were extensively screened for multiple other health problems and medication use. Bone mineral densities were measured and patients were monitored for any occurrence of fractures over a 2-year period, and mortality data collected for 99% of the subjects. Black women and men were excluded from the study due to their lower risk of osteoporotic fractures.
Women in this group (mean age, 72 years) had an average resting heart rate of 69 ± 10 beats/min. Only 1.3% had a pulse of 50 or below, and 15.5% had a rate 80 and above. Women with higher pulse rates were more likely to be heavier, less active, to smoke, and to report diabetes, hypertension, and have low bone mineral density.
Even after adjusting for potential confounders such as age, weight, physical activity, hyperthyroidism, and current smoking, women with a resting pulse of 80 beats/min and above had a 1.6-fold increased risk of hip, pelvis and rib fractures, and a 1.9-fold increased risk of vertebral fractures. Comparing the adjusted subjects in groups sorted by resting pulse rates starting at 60 beats/min, each increase of 10 beats/min resulted in a 1.2-fold increase in fracture risk for hip and vertebral fractures. Fractures in other sites did not necessarily demonstrate the increasing risk, but this was thought to reflect low numbers in those groups.
Mortality risk for all causes and for cardiovascular diseases also demonstrated the association with resting pulse rates 80 and above, which was not present for mortality from cancer or stroke. Excluding women who took estrogens, beta blockers or calcium channel blockers did not affect the association.
Comment by Mary Elina Ferris, MD
Despite our ever-growing technological means to detect disease and predict risk, this study suggests that the simple measurement of a resting pulse rate can provide useful information about our patients’ health. The association with increased risk of death and certain osteoporotic fractures in older women was linear in nature, similar to risks associated with increased blood pressure for both sexes.
Previous studies have suggested a similar association in older men with higher resting pulse rates as a risk predictor for cardiovascular mortality and all-cause mortality.1 It is not difficult to imagine that rapid resting heart rate may reflect general poor health, or at least poor physical fitness. However, this study did not find that the rapid rates correlated with the subjects’ self-reported health or activity levels, nor with objective measures such as decreased grip strength or the inability to rise from a chair without using one’s arms.
Kado and colleagues suggest that rapid heart rate may reflect "long-standing cumulative stress" which has some literature support in association with cardiovascular disease and osteoporotic fractures, possibly by increased sympathetic nerve activity, which results in the production of interleukin-6.2 They argue that clinicians should use a cutoff of 80 beats/min rather than 100 as the definition of tachycardia and its associated risks.
One can’t help but be struck by this research validation of a diagnostic maneuver used for centuries in Chinese medicine and other alternative approaches: the simple palpation of peripheral pulse rate as an indication of disease. Although we may not fully understand the underlying mechanisms, it provides support for the persistent value of our clinical skills in assessing the patient with our human touch.
Dr. Ferris, Clinical Associate Professor, University of Southern California, is Associate Editor of Internal Medicine Alert.
References
1. Palatini P, et al. Arch Intern Med. 1999;159:585-592.
2. Papanicolaou DA, et al. Ann Intern Med. 1998;128: 127-137.
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