Resting Heart Rate Is Not a Good Predictor of a Clustered Cardiovascular Risk Score in Adolescents: The HELENA Study

<div><p>Background</p><p>Resting heart rate (RHR) reflects sympathetic nerve activity a significant association between RHR and all-cause and cardiovascular mortality has been reported in some epidemiologic studies.</p><p>Methods</p><p>To analyze the predictive power and accuracy of RHR as a screening measure for individual and clustered cardiovascular risk in adolescents. The study comprised 769 European adolescents (376 boys) participating in the HELENA cross-sectional study (2006–2008) were included in this study. Measurements on systolic blood pressure, HOMA index, triglycerides, TC/HDL-c, VO₂máx and the sum of four skinfolds were obtained, and a clustered cardiovascular disease (CVD) risk index was computed. The receiver operating characteristics curve was applied to calculate the power and accuracy of RHR to predict individual and clustered CVD risk factors.</p><p>Results</p><p>RHR showed low accuracy for screening CVD risk factors in both sexes (range 38.5%–54.4% in boys and 45.5%–54.3% in girls). Low specificity’s (15.6%–19.7% in boys; 18.1%–20.0% in girls) were also found. Nevertheless, the sensitivities were moderate-to-high (61.4%–89.1% in boys; 72.9%–90.3% in girls).</p><p>Conclusion</p><p>RHR is a poor predictor of individual CVD risk factors and of clustered CVD and the estimates based on RHR are not accurate. The use of RHR as an indicator of CVD risk in adolescents may produce a biased screening of cardiovascular health in both sexes.</p></div

Final sample size flowchart.

<p>*Missing data for accelerometry datas.</p

Accuracy of resting heart rate in screening of individual and clustered cardio-metabolic risk factors in adolescents from HELENA study.

<p>CI 95% = confidence interval 95%; SE = Standard error;HDLc = High-density lipoprotein cholesterol; TC = total cholesterol.</p><p>Accuracy of resting heart rate in screening of individual and clustered cardio-metabolic risk factors in adolescents from HELENA study.</p

Association between resting heart rate and individual and clustered cardio-metabolic risk factors in adolescents from HELENA study.

<p>CI 95% = confidence interval 95%; SE = Standard Error; HDLc = High-density lipoprotein cholesterol; TC = total cholesterol.</p><p>Association between resting heart rate and individual and clustered cardio-metabolic risk factors in adolescents from HELENA study.</p

The relationship between clinical parameters and weight regain.

<p>The association between BMI (A, B), fasting insulin (C, D), HOMA-IR (E, F), and fasting glucose (G, H) and relative weight regain were assessed by Spearman’s ρ correlation analysis. A, C, E, and G illustrate the relationship between baseline CID1 parameters and weight regain, while B, D, F, and H illustrate the relationship between differential parameters (i.e. ΔCID2-CID1) and weight regain. Relative weight regain  = 1 represents a 100% regain in body weight. ^ap<0.05 was considered statistically significant.</p

Flowchart for subject selection from the DiOGenes cohort.

<p>Flowchart for subject selection from the DiOGenes cohort.</p

Differences in anthropometric and clinical parameters between women and men.

<p>Box plots depicting LCD induced changes (i.e. ΔCID2-CID1) in anthropometric and clinical parameters for females (white) and males (grey). ^ap<0.05 between male and female values when conducting Student’s t-tests was considered statistically significant.</p

Multiple linear regression analysis evaluating the association between systolic blood pressure according to independent variables for each study, in boys.

<p>Beta coefficient and their respective confidence intervals 95% (95% CI).</p>*<p>This analysis was adjusted for potential confounders: <i>age, socioeconomic status, parental education, regular tobacco smoking, body mass index and waist circumference.</i></p>**<p>420 boys were excluded because they met the inclusion criteria.</p><p>MPA = moderate physical activity.</p><p>VPA = vigorous physical activity.</p><p>MVPA = moderate and vigorous physical activity.</p><p>PA = physical activity.</p><p>SB = sedentary behavior.</p><p>Significant associations are in bold.</p

Multiple linear regression analysis evaluating the association between systolic blood pressure according to independent variables for each study, in girls.

<p>Beta coefficient and their respective confidence intervals 95% (95% CI).</p>*<p>This analysis was adjusted for potential confounders: <i>age, socioeconomic status, parental education, regular tobacco smoking, body mass index and waist circumference.</i></p>**<p>622 girls were excluded because they did not meet the inclusion criteria.</p><p>MPA = moderate physical activity.</p><p>VPA = vigorous physical activity.</p><p>MVPA = moderate and vigorous physical activity.</p><p>PA = physical activity.</p><p>SB = sedentary behavior.</p><p>Significant associations are in bold.</p

Multiple linear regression analysis evaluating the association between diastolic blood pressure according to independent variables for each study, in girls.

<p>Beta coefficient and their respective confidence intervals 95% (95% CI).</p>*<p>This analysis was adjusted for potential confounders: <i>age, socioeconomic status, parental education, regular tobacco smoking, body mass index and waist circumference.</i></p>**<p>622 girls were excluded because they did not meet the inclusion criteria.</p><p>MPA = moderate physical activity.</p><p>VPA = vigorous physical activity.</p><p>MVPA = moderate and vigorous physical activity.</p><p>PA = physical activity.</p><p>SB = sedentary behavior.</p><p>Significant associations are in bold.</p