American Journal of Epidemiology Vol. 145, No. 10: 899-908
Copyright © 1997 by The Johns Hopkins University School of Hygiene and Public Health
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Heart Rate Variability from Short Electrocardiographic Recordings Predicts Mortality from All Causes in Middle-aged and Elderly Men
The Zutphen Study
1Department of Epidemiology and Public Health, Agricultural University, Wageningen, Netherlands
2Thorax Center, Erasmus University, Rotterdam, Netherlands
3Department of Cardiology, University Hospital, Leiden, Netherlands
4 Division of Public Health Research, National Institute of Public Health and the Environment, Bilthoven, Netherlands
Correspondence to Dr. Jacqueline M. Dekker, Institute for Research in Extramural Medicine, van der Boechorststraat 7, 1081 BT Amsterdam, Netherlands.
Low heart rate variability is associated with high risk of sudden death in myocardial infarction patients. This has been attributed to unfavorable autonomic cardiac control. In the present study, the predictive value of heart rate variability for sudden death, mortality from coronary heart disease, and from all causes was investigated in the general population, using brief electrocardiographic recordings. From 1960 to 1985, 878 middle-aged Dutch men, aged 40–60 years, were followed and repeatedly examined as part of the Zutphen Study. In 1985 the remaining cohort was extended to 885 elderly men, aged 65–85 years, and followed until 1990. Heart rate variability (standard deviation of duration of normal RR intervals) was determined from the resting 12-lead electrocardiogram. The 5-year age-adjusted relative rate of total mortality of men with heart rate variability of <20 milliseconds (msec) compared with men with heart rate variability of 20–39 msec was 2.1 (95 percent confidence interval 1.4–3.0) in middle-aged men and 1.4 (95% confidence interval 0.9–2.2) in elderly men. Death from noncoronary causes, especially cancer, contributed significantly to this elevated risk. The association of low heart rate variability with sudden death or coronary heart disease mortality was less consistent. In conclusion, in middle-aged men and probably in elderly men, low heart rate variability is predictive of mortality from all causes. This suggests that low heart rate variability is an indicator of compromised health in the general population. Am J Epidemiol 1997; 145: 899–908.
aged; autonomic nervous system; electrocardiography; heart rate; men; middle age; mortality; population
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