{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:55:10Z","timestamp":1787018110300,"version":"build-2736575974"},"reference-count":30,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2025,5,6]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Simple biometrics such as peak heart rate and exercise duration remain core predictors of cardiovascular disease (CVD). Commercial wearable devices track physical and cardiac electrical activity. Detailed, longitudinal data collection from wearables presents a valuable opportunity to identify new factors associated with CVD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods and Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      This cross\u2010sectional study analyzed 6947 participants in the Fitbit Bring\u2010Your\u2010Own\u2010Device Project, a subset of the All of Us Research Program. The primary exposure daily heart rate per step (DHRPS) was defined as the average daily heart rate divided by steps per day. Our analysis correlated DHRPS with established CVD factors (type 2 diabetes, hypertension, stroke, heart failure, coronary atherosclerosis, myocardial infarction) as primary outcomes. We also performed a DHRPS\u2010based phenome\u2010wide association study on the spectrum of human disease traits for all 1789 disease codes across 17 disease categories. Secondary outcomes included maximum metabolic equivalents achieved on cardiovascular treadmill exercise stress testing. We examined 5.8 million person\u2010days and 51 billion total steps of individual\u2010level Fitbit data paired with electronic health record data. Elevated DHRPS was associated with type 2 diabetes (odds ratio [OR], 2.03 [95% CI, 1.70\u20132.42]), hypertension (OR, 1.63 [95% CI, 1.32\u20132.02]), heart failure (OR, 1.77 [95% CI, 1.00\u20133.14]), and coronary atherosclerosis (OR, 1.44 [95% CI, 1.14\u20131.82]), even after adjusting for daily heart rate (DHR) and step count. DHRPS also had stronger correlations with maximum metabolic equivalents achieved on exercise stress testing compared with steps per day (\u2206\u03c1=0.04,\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &lt;0.001) and heart rate (\u2206\u03c1=0.31,\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &lt;0.001). Lastly, DHRPS\u2010based phenome\u2010wide association study demonstrated stronger associations with CVD factors (\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &lt;1\u00d710\n                      <jats:sup>\u221255<\/jats:sup>\n                      ) compared with daily heart rate or step count.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">In the All of Us Research Program Fitbit Bring\u2010Your\u2010Own\u2010Device Project, DHRPS was an easy\u2010to\u2010calculate wearables metric and was more strongly associated with cardiovascular fitness and CVD outcomes than DHR and step count.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.124.036801","type":"journal-article","created":{"date-parts":[[2025,3,29]],"date-time":"2025-03-29T11:00:28Z","timestamp":1743246028000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":10,"title":["Daily Heart Rate per Step: A Wearables Metric Associated With Cardiovascular Disease in a Cross\u2010Sectional Study of the\n                    <i>All of Us<\/i>\n                    Research Program"],"prefix":"10.1161","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5835-3840","authenticated-orcid":false,"given":"Zhanlin","family":"Chen","sequence":"first","affiliation":[{"name":"Northwestern University","place":["Chicago, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles T.","family":"Wang","sequence":"additional","affiliation":[{"name":"Northwestern University","place":["Chicago, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6218-4034","authenticated-orcid":false,"given":"Carolyn J.","family":"Hu","sequence":"additional","affiliation":[{"name":"Northwestern University","place":["Chicago, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-0012-7750","authenticated-orcid":false,"given":"Kendra","family":"Ward","sequence":"additional","affiliation":[{"name":"Northwestern University Feinberg School of Medicine","place":["Chicago, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1993-5634","authenticated-orcid":false,"given":"Abel","family":"Kho","sequence":"additional","affiliation":[{"name":"Northwestern University Feinberg School of Medicine","place":["Chicago, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9107-8342","authenticated-orcid":false,"given":"Gregory","family":"Webster","sequence":"additional","affiliation":[{"name":"Northwestern University Feinberg School of Medicine","place":["Chicago, 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