Evidence map›Paper›PMID 24356937›Full record

Trial reportClinical research in cardiology : official journal of the German Cardiac Society2014

Heart rate is associated with increased risk of major cardiovascular events, cardiovascular and all-cause death in patients with stable chronic cardiovascular disease: an analysis of ONTARGET/TRANSCEND.

Eva M Lonn, Sherryn Rambihar, Peggy Gao, Florian F Custodis, Karen Sliwa, Koon K Teo, Salim Yusuf, Michael Böhm

Abstract readMulticenter StudyRandomized Controlled Trial
PubMed Publisher
In one paragraph

Trial report in Clinical research in cardiology : official journal of the German Cardiac Society, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 76 papers, 8 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
76citing papers in PubMed, 8 pooled it
8.5field-weighted citation impact, top 2% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

76 citing papers in PubMed, 8 syntheses or guidelines pooled it, 143 citations in OpenAlex.

  1. Guideline
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  8. Investigating the role of acute mental stress on endothelial dysfunction: a systematic review and meta-analysis.Clinical research in cardiology : official journal of the German Cardiac Society · 2015
    Pooled it
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  10. Resting Heart Rate and Ischemic Stroke in Patients with Heart Failure.Cerebrovascular diseases (Basel, Switzerland) · 2017
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  16. Article
  17. Interpreting ECG-Based Risk Stratification in Women With INOCA: Methodological Considerations From the WISE Cohort.Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc · 2026
    Article
  18. Cardiac event-induced PTSD symptoms and continuous heart rate in coronary artery disease patients.Health psychology : official journal of the Division of Health Psychology, American Psychological Association · 2026
    Article
  19. Electrocardiographic Predictors of Major Adverse Cardiovascular Events in Women With Suspected Ischemia and no Obstructive Coronary Artery Disease: Results of the Women's Ischemia Syndrome Evaluation.Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc · 2026
    Article
  20. Article

16 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 3 institutions in 2 countries.

Eva M LonnDivision of Cardiology, Department of Medicine, McMaster University, Hamilton, ON, Canada.
Sherryn Rambihar
Peggy Gao
Florian F Custodis
Karen Sliwa
Koon K Teo
Salim Yusuf
Michael Böhm
McMaster University · CAPopulation Health Research Institute · CAUniversitätsklinikum des Saarlandes · DE

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

aimsHeart rate was proposed as an emergent cardiovascular (CV) risk factor. Previous studies have shown associations between increased heart rate and CV risk in various populations. We aimed to evaluate the prognostic relevance of heart rate in a large contemporaneous medically optimized cohort of patients with stable chronic CV disease. METHODS AND

resultsIn a post hoc analysis of the ONTARGET/TRANSCEND trials, we evaluated associations between baseline and average heart rate in trial with CV risk in 31, 531 patients followed for a median of 5 years. The primary outcome, major vascular events (MVE), was a composite of CV death, myocardial infarction (MI), stroke, and congestive heart failure (CHF). Pre-specified secondary outcomes included all-cause death and the individual components of the primary outcome. Associations between heart rate and outcomes were computed with heart rate as a continuous variable, baseline heart rate >70 vs ≤ 70 bpm, and across heart rate quintiles, adjusting for other markers of risk, beta-blocker and non-dihydropyridine calcium channel blocker use. For each 10 bpm increase in baseline and average heart rate, we observed a significant increase in risk of MVE, CV death, CHF and all-cause death. There was a continuous relationship between MVE and baseline and, more importantly, average in-trial heart rate, with no observed threshold. MVE, CV death, stroke, CHF, and all-cause death increased across heart rate quintiles. There was no association between MI and HR. Results were consistent in clinically relevant subgroups. There were modest but significant improvements in C-statistic and in statistical measures of model calibration for models that included heart rate for MVE, CV death, CHF and all-cause death.

conclusionsThis large study examined and quantitated associations between heart rate and CV events in a contemporary medically optimized population with stable CV disease. Resting and, in particular, in-trial average heart rate are independently associated with significant increases in CV events and all-cause death.

Indexed as

Heart RateAgedAngiotensin-Converting Enzyme InhibitorsAngiotensin II Type 1 Receptor BlockersCardiovascular DiseasesCause of DeathChronic DiseaseDouble-Blind MethodFemaleHeart FailureHumansKaplan-Meier EstimateMaleMiddle AgedMyocardial InfarctionPrognosisAngiotensin-Converting Enzyme InhibitorsAngiotensin II Type 1 Receptor Blockers

Identifiers

PMID24356937
OpenAlexW1977566849

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.