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Original Investigation |

Association of Asymptomatic Bradycardia With Incident Cardiovascular Disease and Mortality The Multi-Ethnic Study of Atherosclerosis (MESA)

Ajay Dharod, MD1; Elsayed Z. Soliman, MD, MSc, MS2,3; Farah Dawood, MD2; Haiying Chen, MD, PhD4; Steven Shea, MD, MS5,6; Saman Nazarian, MD, PhD7,8; Alain G. Bertoni, MD1,3 ; for the MESA Investigators
[+] Author Affiliations
1Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
2Section of Cardiology, Wake Forest School of Medicine, Winston-Salem, North Carolina
3Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
4Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
5Department of Medicine, Columbia University, New York, New York
6Department of Epidemiology, Columbia University, New York, New York
7Department of Medicine/Cardiology, Johns Hopkins Health System, Baltimore, Maryland
8Department of Epidemiology, Johns Hopkins Health System, Baltimore, Maryland
JAMA Intern Med. 2016;176(2):219-227. doi:10.1001/jamainternmed.2015.7655.
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Importance  Bradycardia has been associated with lower cardiovascular disease (CVD) risk in selected populations. There is a paucity of information available about heart rate (HR) less than 50 beats per minute (bpm) among middle-aged or older adults.

Objective  To determine whether asymptomatic bradycardia was associated with a lower cardiovascular risk profile, less subclinical atherosclerosis, and decreased incident CVD and mortality.

Design, Setting, and Participants  This retrospective analysis includes 6733 participants of the Multi-Ethnic Study of Atherosclerosis, which recruited men and women free of clinical cardiovascular disease ages 45 to 84 years from 2000 to 2002 and followed them over 10 years for incident CVD events and mortality. The HR was measured by baseline electrocardiogram. The analysis was performed in June 2014.

Main Outcomes and Measures  The association between HR categories with CVD events and all-cause mortality were examined using Cox proportional hazards models adjusted for potential confounders and mediators.

Results  The 6733 participants had a mean (SD) age of 62 (10.2) years; 47% were male. The mean (SD) HR was 63 (9.5) bpm among the 5831 participants not taking an HR-modifying drug; 5.3% had an HR lower than 50 bpm. Preliminary results revealed significant interaction for HR categories according to use of HR-modifying drugs for mortality (P = .002); thus, all further analyses were stratified. An HR of less than 50 bpm was not associated with incident CVD in either subgroup (participants taking or not taking HR-modifying drugs). Among participants not taking HR-modifying drugs, the fully adjusted mortality risk was not different for an HR less than 50 bpm (hazard ratio, 0.71 [95% CI, 0.41-1.09]; P = .12) and increased among those with an HR greater than 80 bpm (hazard ratio, 1.49 [95% CI, 1.08-2.05]; P = .01) (reference HR, 60-69 bpm). Among the 902 participants taking HR-modifying drugs there was an elevated mortality risk associated with an HR less than 50 bpm (hazard ratio, 2.42 [95% CI, 1.39-4.20]; P = .002) and with an HR greater than 80 bpm (hazard ratio, 3.55 [95% CI, 1.65-7.65]; P = .001) (reference HR, 60-69 bpm).

Conclusions and Relevance  In a contemporary, community-based cohort, bradycardia was generally not associated with incident CVD or mortality except for a potential adverse association between bradycardia among those taking HR-modifying drugs.

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Figure.
Mortality per 1000 Person-years by Heart Rate (HR) Category

Mortality in the entire sample and among participants taking or not taking drugs affecting heart rate. Light bars indicate rate among those not taking HR-modifying drugs; dark bars indicate rate for participants taking drugs affecting HR. Error bars indicate 95% CIs.

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Submit a Comment
Bradycardia Fibrillation and Lisinopril.
Posted on January 22, 2016
M. Cawdery
Retired research veterinarian
Conflict of Interest: None Declared
In a contemporary, community-based cohort, bradycardia was generally not associated with incident CVD or mortality except for a potential adverse association between bradycardia among those taking HR-modifying drugs.

I have had this confirmed by the UK MHRA with a long letter. In my own case as BP dropped below 60 mmHg, the incidence of “fibrillation” increased rapidly. It seems that drugs of the lisinopril class are those most involved. They were unable to say how many patients also suffered AF.

I just wonder how many realize this
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