{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T11:08:00Z","timestamp":1789556880140,"version":"build-2803163510"},"reference-count":39,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T00:00:00Z","timestamp":1784073600000},"content-version":"unspecified","delay-in-days":14,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100018537","name":"National Science and Technology Major Project","doi-asserted-by":"publisher","award":["2023ZD0509400"],"award-info":[{"award-number":["2023ZD0509400"]}],"id":[{"id":"10.13039\/501100018537","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2026,7,4]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Elevated resting heart rate (RHR) predicts mortality in middle-aged and older adults, primarily through cardiovascular disease (CVD). Whether RHR predicts mortality in young adults, which causes of death are involved and whether the association replicates are unclear. In young US adults, who fall below the starting age of current cardiovascular risk tools, we examined RHR and all-cause and cause-specific mortality across two cohorts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analysed 3291 adults aged 20\u201349 years from National Health and Nutrition Examination Survey (NHANES) 1999\u20132004 (primary cohort) linked to mortality through 2019 (median follow-up 17.8 years; 120 deaths) with replication in 8941 adults from NHANES III (1988\u20131994; 1317 deaths; median follow-up 27.6 years; temporal replication). RHR and heart rate reserve (HRR) were modelled per 10 beats per minute increment using Cox regression adjusted for demographic, lifestyle and comorbidity covariates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Each 10 beats per minute higher RHR was associated with higher all-cause mortality (primary cohort: HR, 1.26; 95%\u2009CI 1.07 to 1.50; validation: HR, 1.17; 95%\u2009CI 1.12 to 1.22). In the primary cohort most deaths (99 of 120) were non-CVD; the CVD-specific analysis was underpowered (21 deaths; HR, 1.15; 95%\u2009CI 0.77 to 1.71). In validation, RHR predicted non-CVD (HR, 1.17; 95%\u2009CI 1.11 to 1.23)\u2009and CVD (HR, 1.18; 95%\u2009CI 1.08 to 1.29)\u2009mortality about equally. The association strengthened with age, emerging by the early-to-mid 30\u2009s in both cohorts, before the starting age of current risk tools. HRR, measured under submaximal conditions, was not associated with any outcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In young US adults, elevated resting heart rate, a free and routinely measured vital sign, predicts long-term mortality across two cohorts, marking broad survival vulnerability rather than cardiovascular risk alone. Detectable in the early-to-mid 30\u2009s, below the starting age of current cardiovascular risk tools, resting heart rate may flag at-risk young adults before these tools apply. Submaximal HRR carried no prognostic value.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/openhrt-2026-004279","type":"journal-article","created":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T12:05:49Z","timestamp":1784117149000},"page":"e004279","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Resting heart rate and long-term mortality in young adults: a population-based cohort study"],"prefix":"10.1136","volume":"13","author":[{"given":"Huizhen","family":"Chen","sequence":"first","affiliation":[{"name":"Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China"},{"name":"King\u2019s College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1089-4194","authenticated-orcid":false,"given":"Qiu","family":"Chen","sequence":"additional","affiliation":[{"name":"Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0768-1676","authenticated-orcid":false,"given":"Yanzhong","family":"Wang","sequence":"additional","affiliation":[{"name":"King\u2019s College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,7,15]]},"reference":[{"key":"2026091603501419000_13.2.e004279.1","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.150535"},{"key":"2026091603501419000_13.2.e004279.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.numecd.2017.04.004"},{"key":"2026091603501419000_13.2.e004279.3","doi-asserted-by":"publisher","DOI":"10.1016\/0002-8703(87)90666-1"},{"key":"2026091603501419000_13.2.e004279.4","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1177\/2047487312452501","article-title":"The association between resting heart rate, cardiovascular disease and mortality: evidence from 112,680 men and women in 12 cohorts","volume":"21","author":"Woodward","year":"2014","journal-title":"Eur J Prev Cardiolog"},{"key":"2026091603501419000_13.2.e004279.5","doi-asserted-by":"publisher","DOI":"10.1081\/CEH-200031959"},{"key":"2026091603501419000_13.2.e004279.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2014.09.016"},{"key":"2026091603501419000_13.2.e004279.7","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1016\/j.tcm.2022.05.006","article-title":"Importance of resting heart rate","volume":"33","author":"Olshansky","year":"2023","journal-title":"Trends Cardiovasc Med"},{"key":"2026091603501419000_13.2.e004279.8","doi-asserted-by":"publisher","DOI":"10.1016\/0002-8703(91)90970-S"},{"key":"2026091603501419000_13.2.e004279.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2016.11.059"},{"key":"2026091603501419000_13.2.e004279.10","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.aje.a009901"},{"key":"2026091603501419000_13.2.e004279.11","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.120.046677"},{"key":"2026091603501419000_13.2.e004279.12","doi-asserted-by":"crossref","first-page":"30T","DOI":"10.1016\/S0002-9149(98)00720-6","article-title":"Determinants of atherosclerosis in the young. Pathobiological Determinants of Atherosclerosis in Youth (PDAY) Research Group","volume":"82","author":"McGill","year":"1998","journal-title":"Am J Cardiol"},{"key":"2026091603501419000_13.2.e004279.13","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.110.940577"},{"key":"2026091603501419000_13.2.e004279.14","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199910283411804"},{"key":"2026091603501419000_13.2.e004279.15","doi-asserted-by":"publisher","DOI":"10.1001\/jama.281.6.524"},{"key":"2026091603501419000_13.2.e004279.16","doi-asserted-by":"publisher","DOI":"10.1016\/0021-9681(87)90171-8"},{"key":"2026091603501419000_13.2.e004279.17","first-page":"1","article-title":"Deaths: Leading Causes for 2020","volume":"72","author":"Curtin","year":"2023","journal-title":"Natl Vital Stat Rep"},{"key":"2026091603501419000_13.2.e004279.18","first-page":"1\u2013115","article-title":"Deaths: Leading Causes for 2023","volume":"74","author":"Tejada-Vera","year":"2025","journal-title":"Natl Vital Stat Rep"},{"key":"2026091603501419000_13.2.e004279.19","doi-asserted-by":"publisher","DOI":"10.1016\/S0165-0327(00)00338-4"},{"key":"2026091603501419000_13.2.e004279.20","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1503\/jpn.140217","article-title":"Autonomic nervous system dysfunction in psychiatric disorders and the impact of psychotropic medications: a systematic review and meta-analysis","volume":"41","author":"Alvares","year":"2016","journal-title":"J Psychiatry Neurosci"},{"key":"2026091603501419000_13.2.e004279.21","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1111\/j.1749-6632.1996.tb32508.x","article-title":"Autonomic nervous system factors underlying disinhibited, antisocial, and violent behavior. Biosocial perspectives and treatment implications","volume":"794","author":"Raine","year":"1996","journal-title":"Ann N Y Acad Sci"},{"key":"2026091603501419000_13.2.e004279.22","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1016\/j.psychres.2016.04.033","article-title":"Heart rate variability and suicidal behavior","volume":"240","author":"Wilson","year":"2016","journal-title":"Psychiatry Res"},{"key":"2026091603501419000_13.2.e004279.23","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1111\/acps.12513","article-title":"Heart rate and suicide: findings from two cohorts of 533 000 Taiwanese and 75 000 Norwegian adults","volume":"133","author":"Chang","year":"2016","journal-title":"Acta Psychiatr Scand"},{"key":"2026091603501419000_13.2.e004279.24","first-page":"1","article-title":"Deaths: Leading Causes for 2019","volume":"70","author":"Heron","year":"2021","journal-title":"Natl Vital Stat Rep"},{"key":"2026091603501419000_13.2.e004279.25","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2013.11.009"},{"key":"2026091603501419000_13.2.e004279.26","doi-asserted-by":"publisher","DOI":"10.1038\/nature01322"},{"key":"2026091603501419000_13.2.e004279.27","doi-asserted-by":"crossref","DOI":"10.3390\/jcm10071354","article-title":"Resting Heart Rate as a Predictor of Cancer Mortality: A Systematic Review and Meta-Analysis","volume":"10","author":"Pozuelo-Carrascosa","year":"2021","journal-title":"J Clin Med"},{"key":"2026091603501419000_13.2.e004279.28","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0233898","article-title":"Age, sex and disease-specific associations between resting heart rate and cardiovascular mortality in the UK BIOBANK","volume":"15","author":"Raisi-Estabragh","year":"2020","journal-title":"PLoS One"},{"key":"2026091603501419000_13.2.e004279.29","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehab309"},{"key":"2026091603501419000_13.2.e004279.30","doi-asserted-by":"publisher","DOI":"10.1161\/01.cir.0000437741.48606.98"},{"key":"2026091603501419000_13.2.e004279.31","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000678"},{"key":"2026091603501419000_13.2.e004279.32","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.123.067626"},{"key":"2026091603501419000_13.2.e004279.33","doi-asserted-by":"publisher","DOI":"10.1177\/003335490612100615"},{"key":"2026091603501419000_13.2.e004279.34","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6617e1"},{"key":"2026091603501419000_13.2.e004279.35","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2004.060749"},{"key":"2026091603501419000_13.2.e004279.36","doi-asserted-by":"publisher","DOI":"10.1016\/S1047-2797(00)00047-8"},{"key":"2026091603501419000_13.2.e004279.37","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.aje.a010013"},{"key":"2026091603501419000_13.2.e004279.38","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.81.9.1166"},{"key":"2026091603501419000_13.2.e004279.39","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pbio.3003152","article-title":"Explosion of formulaic research articles, including inappropriate study designs and false discoveries, based on the NHANES US national health database","volume":"23","author":"Suchak","year":"2025","journal-title":"PLoS Biol"}],"container-title":["Open Heart"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/openhrt-2026-004279","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T10:50:31Z","timestamp":1789555831000},"score":1,"resource":{"primary":{"URL":"https:\/\/openheart.bmj.com\/lookup\/doi\/10.1136\/openhrt-2026-004279"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":39,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,7,15]]},"published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1136\/openhrt-2026-004279"],"URL":"https:\/\/doi.org\/10.1136\/openhrt-2026-004279","relation":{},"ISSN":["2053-3624"],"issn-type":[{"value":"2053-3624","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]}}}