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dc.contributor.advisorBrenn, Tormod
dc.contributor.authorSharashova, Ekaterina
dc.date.accessioned2017-05-08T09:10:26Z
dc.date.available2017-05-08T09:10:26Z
dc.date.issued2017-02-10
dc.description.abstractBackground: Resting heart rate (RHR) is an easily measured cardiovascular parameter that is considered an independent predictor of cardiovascular disease (CVD) and mortality in the general population. However, results on the association between RHR and these outcomes are inconsistent, and studies on longitudinal trends in RHR and the role of long-term changes in RHR in CVD and mortality are scarce. <br>Objective: To investigate secular trends in RHR in the general population of Tromsø, Northern Norway over the last decades, and to explore the role of RHR and long-term changes in RHR in CVD and mortality. <br>Methods: Participants from four surveys of the Tromsø Study conducted between 1986 and 2008 were included in these analyses (n=34 751). RHR in these participants was measured with an automated Dinamap device and resultant data were linked to validated information on incident myocardial infarction, atrial fibrillation, ischemic stroke, cardiovascular death and total death. Statistical methods included mixed models analysis, fractional polynomials, and trajectory analysis. <br>Main results: Over 22 years of observation, the mean age-adjusted RHR declined from 73.4 to 64.7 beats per minute in men, and from 78.3 to 66.4 beats per minute in women; 17.4% of the decline in men and 16.1% of the decline in women was attributable to favourable changes in other cardiovascular risk factors. In men, elevated RHR independently predicted the risk of myocardial infarction, atrial fibrillation, and cardiovascular death. In women, the associations with myocardial infarction and total death were similar to those in men, and we found a J-shaped association with ischemic stroke. Having a constantly elevated RHR or a RHR that increased from moderate to high over 15 years increased the risk of myocardial infarction, cardiovascular death, and total death in men, whereas estimates in women were insignificant. <br>Conclusions: Over the last decades RHR has declined substantially, and this decline has occurred to a large extent independently of other cardiovascular risk factors. RHR independently predicts the risk of CVD and mortality though there are sex differences. Long-term changes in RHR provide additional information for risk assessment. Thus, RHR is as an independent cardiovascular risk factor, and as such it should be monitored and used in risk assessments by both people themselves and by health professionals. RHR is a modifiable cardiovascular risk factor; however it is unclear whether people could benefit from RHR-lowering interventions.en_US
dc.description.doctoraltypeph.d.en_US
dc.description.popularabstractHvilepulsen gikk ned i Tromsø: folk er sunnere. I løpet av de siste tiårene falt hvilepulsen hos befolkningen i Tromsø med omlag 10 slag i minuttet viser Tromsøundersøkelsen. Studien viser også at hvilepuls og langsiktige endringer i hvilepuls forutsier fremtidig risiko for kardiovaskulær sykdom og død. Fra 1986 til 2008 falt hvilepulsen i Tromsø med omlag 9 slag i minuttet hos menn og 12 hos kvinner i alle aldre. I stor grad var nedgangen i hvilepuls uavhengig av andre kardiovaskulære risikofaktorer, og mindre enn en femtedel av nedgangen var assosiert med gunstige endringer i blodlipider, blodtrykk, fysisk aktivitet, røyking, kroppsmasseindeks og behandling av blodtrykk. Denne nedadgående trenden i hvilepuls anses som gunstig fordi høy hvilepuls er assosiert med økt risiko for hjerteinfarkt og død hos begge kjønn og også økt risiko for atrieflimmer hos menn og iskemisk hjerneslag hos kvinner. Menn med lave nivåer av hvilepuls gjennom voksenlivet hadde lavere risiko for hjerteinfarkt og død enn alle andre typer forløp av hvilepuls over tid. Vi undersøkte ikke om personer med moderat og høy hvilepuls kan ha nytte av å senke hvilepulsen, men overvåking av hvilepulsen og dens variasjon kan brukes til risikovurdering og prognose.en_US
dc.descriptionThe papers of this thesis are not available in Munin. <p> Paper I: Sharashova, E., Wilsgaard, T., Brenn, T.: “Resting heart rate on the decline: the Tromsø Study 1986-2007”. Available in <a href=https://doi.org/10.1093/ije/dyv061> Int J Epidemiol 2015, 44(3):1007-1017. </a> <p> Paper II: Sharashova, E., Wilsgaard, T., Mathiesen, E. B., Løchen, M. L., Njølstad, I., Brenn, T.: “Resting heart rate predicts incident myocardial infarction, atrial fibrillation, ischaemic stroke and death in the general population: the Tromsø Study”. Available in <a href=http://dx.doi.org/10.1136/jech-2015-206663> J Epidemiol Community Health 2016, 70(9):902-909. </a> <p> Paper III: Sharashova, E., Wilsgaard, T., Løchen, M. L., Mathiesen, E. B., Njølstad, I., Brenn, T.: “Resting heart rate trajectories and myocardial infarction, atrial fibrillation, ischemic stroke and death in the general population: the Tromsø Study”. (Manuscript).en_US
dc.identifier.urihttps://hdl.handle.net/10037/10992
dc.language.isoengen_US
dc.publisherUiT The Arctic University of Norwayen_US
dc.publisherUiT Norges arktiske universiteten_US
dc.rights.accessRightsopenAccessen_US
dc.rights.holderCopyright 2017 The Author(s)
dc.subject.courseIDDOKTOR-003
dc.subjectVDP::Medical disciplines: 700::Clinical medical disciplines: 750::Cardiology: 771en_US
dc.subjectVDP::Medisinske Fag: 700::Klinisk medisinske fag: 750::Kardiologi: 771en_US
dc.subjectVDP::Medical disciplines: 700::Health sciences: 800::Preventive medicine: 804en_US
dc.subjectVDP::Medisinske Fag: 700::Helsefag: 800::Forebyggende medisin: 804en_US
dc.subjectThe Tromsø Study
dc.subjectTromsøundersøkelsen
dc.titleDecline in resting heart rate, its association with other variables, and its role in cardiovascular disease The Tromsø Studyen_US
dc.typeDoctoral thesisen_US
dc.typeDoktorgradsavhandlingen_US


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