{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T21:07:43Z","timestamp":1792789663290,"version":"4.5.0"},"reference-count":66,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T00:00:00Z","timestamp":1789948800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Consejer\u00eda de Sanidad de Castilla-La Mancha","award":["OC 7\u20133-92"],"award-info":[{"award-number":["OC 7\u20133-92"]}],"id":[{"id":"https:\/\/ror.org\/00pdx2849","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Consejer\u00eda de Sanidad de Castilla-La Mancha","award":["OC 14\u20139-93"],"award-info":[{"award-number":["OC 14\u20139-93"]}],"id":[{"id":"https:\/\/ror.org\/00pdx2849","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Consejer\u00eda de Sanidad de Castilla-La Mancha","award":["5\u20139-2003"],"award-info":[{"award-number":["5\u20139-2003"]}],"id":[{"id":"https:\/\/ror.org\/00pdx2849","id-type":"ROR","asserted-by":"crossref"}]},{"award":["OC 7\u20133-92"],"award-info":[{"award-number":["OC 7\u20133-92"]}],"id":[{"id":"https:\/\/ror.org\/00pdx2849","id-type":"ROR","asserted-by":"publisher"}]},{"award":["OC 14\u20139-93"],"award-info":[{"award-number":["OC 14\u20139-93"]}],"id":[{"id":"https:\/\/ror.org\/00pdx2849","id-type":"ROR","asserted-by":"publisher"}]},{"award":["5\u20139-2003"],"award-info":[{"award-number":["5\u20139-2003"]}],"id":[{"id":"https:\/\/ror.org\/00pdx2849","id-type":"ROR","asserted-by":"publisher"}]},{"name":"Fondo de Investigaci\u00f3n Sanitaria","award":["22\/1164"],"award-info":[{"award-number":["22\/1164"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Objectives: This study evaluated the association of resting heart rate (RHR) with major adverse cardiovascular events (MACEs) and all-cause mortality among adults without prior cardiovascular disease, stratified by baseline burden of cardiovascular risk factors (CVRFs). Methods: This was a prospective cohort study in a random sample of the general population aged \u226518 years in southeastern Spain. RHR was measured using an electrocardiogram. CVRFs (sedentary or light-to-moderate physical activity, body-mass index \u2265 25 kg\/m2, non-HDL cholesterol \u2265 130 mg\/dL, diabetes, hypertension, and smoking) were grouped in three clusters based on whether each subject has 0\u20132, 3, or \u22654 factors. During a mean 21.5-year follow-up, MACEs were collected and classified as all-cause mortality (outcome-1, n = 193 events) and combined cardiovascular morbidity and mortality (outcome-2, n = 291 events). Cox regression models were adjusted for multiple confounders. Results: The mean age of the participants (n = 1169) was 47.4 years (55.8% women). For every 10 bpm increase in RHR, the fully adjusted hazard ratio was 1.15 (95% CI: 1.03\u20131.28) for outcome-1 and 1.09 (1.00\u20131.20) for outcome-2. In the cluster with three CVRFs, the fully adjusted hazard ratios per 10 bpm RHR increase were 1.18 (95% CI 1.04\u20131.36) for outcome-1 and 1.15 (1.03\u20131.27) for outcome-2. In the clusters with 0\u20132 and \u22654 CVRFs, there were no statistically significant differences. Conclusions: RHR was independently associated with both cardiovascular events and all-cause mortality in the 3 CVRF cluster (intermediate cluster in terms of the burden of CVRFs), whose prognostic value may be clinically meaningful. These results highlight the importance of RHR and the comprehensive assessment of CVRFs in the primary prevention setting.<\/jats:p>","DOI":"10.3390\/jcm15187333","type":"journal-article","created":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T11:09:35Z","timestamp":1790075375000},"page":"7333","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Resting Heart Rate Association with Cardiovascular Morbidity and Mortality and All-Cause Mortality According to Cluster of Cardiovascular Risk Factors\u2014A Prospective Cohort Study with More than 20 Years of Follow-Up"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7818-7176","authenticated-orcid":false,"given":"Julio A.","family":"Carbayo-Herencia","sequence":"first","affiliation":[{"name":"Department of Clinical Medicine, Universidad Miguel Hern\u00e1ndez Campus de San Juan, San Juan, 03550 Alicante, Spain"},{"name":"GEVA (Grupo Enfermedades Vasculares Albacete), Chinchilla de Monte-Arag\u00f3n, 02520 Albacete, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-5819-4474","authenticated-orcid":false,"given":"Luis Miguel","family":"Artigao R\u00f3denas","sequence":"additional","affiliation":[{"name":"GEVA (Grupo Enfermedades Vasculares Albacete), Chinchilla de Monte-Arag\u00f3n, 02520 Albacete, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-7210-3250","authenticated-orcid":false,"given":"Marta","family":"Simarro-Rueda","sequence":"additional","affiliation":[{"name":"GEVA (Grupo Enfermedades Vasculares Albacete), Chinchilla de Monte-Arag\u00f3n, 02520 Albacete, Spain"},{"name":"Zona 4 Primary Care Center, 02006 Albacete, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2865-6768","authenticated-orcid":false,"given":"Francisca","family":"Molina-Escribano","sequence":"additional","affiliation":[{"name":"GEVA (Grupo Enfermedades Vasculares Albacete), Chinchilla de Monte-Arag\u00f3n, 02520 Albacete, Spain"},{"name":"Chinchilla de Monte-Arag\u00f3n Primary Care Center, Chinchilla de Monte-Arag\u00f3n, 02520 Albacete, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisca","family":"Navarro-Blazquez","sequence":"additional","affiliation":[{"name":"GEVA (Grupo Enfermedades Vasculares Albacete), Chinchilla de Monte-Arag\u00f3n, 02520 Albacete, Spain"},{"name":"Casasimarro Primary Care Center, Casasimarro, 16239 Albacete, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3793-9786","authenticated-orcid":false,"given":"Vicente","family":"Gil-Guill\u00e9n","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine, Universidad Miguel Hern\u00e1ndez Campus de San Juan, San Juan, 03550 Alicante, Spain"},{"name":"GEVA (Grupo Enfermedades Vasculares Albacete), Chinchilla de Monte-Arag\u00f3n, 02520 Albacete, Spain"},{"name":"Unidad de Investigaci\u00f3n HGUA Doctor Balmis, 03010 Alicante, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 R.","family":"Banegas","sequence":"additional","affiliation":[{"name":"GEVA (Grupo Enfermedades Vasculares Albacete), Chinchilla de Monte-Arag\u00f3n, 02520 Albacete, Spain"},{"name":"Department of Preventive Medicine and Public Health, Universidad Aut\u00f3noma de Madrid and CIBERESP, 28029 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9947-8423","authenticated-orcid":false,"given":"Juan Antonio","family":"Divis\u00f3n Garrote","sequence":"additional","affiliation":[{"name":"GEVA (Grupo Enfermedades Vasculares Albacete), Chinchilla de Monte-Arag\u00f3n, 02520 Albacete, Spain"},{"name":"Department of Medicine, Universidad Cat\u00f3lica de Murcia (UCAM), 30107 Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,21]]},"reference":[{"key":"ref_1","first-page":"1104","article-title":"Rest Heart Rate and Life Expectancy","volume":"30","author":"Levine","year":"1997","journal-title":"J. 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