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

PLoS One. 2015 May 26;10(5):e0127530. doi: 10.1371/journal.pone.0127530. eCollection 2015.


Background: 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.

Methods: 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.

Results: 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).

Conclusion: 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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Blood Pressure / physiology*
  • Cardiovascular Diseases / diagnosis*
  • Cardiovascular Diseases / etiology
  • Cardiovascular Diseases / physiopathology
  • Cardiovascular System / physiopathology*
  • Cross-Sectional Studies
  • Female
  • Heart Rate / physiology*
  • Humans
  • Male
  • Risk Factors
  • Sensitivity and Specificity
  • Sympathetic Nervous System / physiopathology*
  • Triglycerides / blood


  • Triglycerides

Grants and funding

The HELENA Study takes place with the financial support of the European Community Sixth RTD Framework Programme (contract FOOD-CT-2005-007034). The writing group takes sole responsibility for the content of this article. This study was also supported by granta from the Spanish Ministry of Health: Maternal, Child Health and Development Network (number RD08/ 0072), the Spanish Ministry of Education (EX-2008- 0641) and the Swedish Heart-Lung Foundation (20090635). Augusto César F. de Moraes was given a PhD Student scholarship from the São Paulo Research Foundation – FAPESP (proc. 2011/11137-1 and 2011/20662-2) and a Post-Doctoral scholarship from the Brazilian Government from the National Counsel of Technological and Scientific Development – CNPq (proc. 471266/2013-2 and 313772/2014-2) and the São Paulo Research Foundation – FAPESP (proc. 2014/13367-2). Alex Jones Flores Cassenote was given a PhD Student scholarship from the São Paulo Research Foundation – FAPESP (proc. 2013/18158-1). Luis A. Moreno was given a visiting professor scholarship from the Brazilian government by Science without Borders Program by CNPq (National Counsel of Technological and Scientific Development) and CAPES (Coordination of Improvement of Higher Education Personnel) (proc. 007/2012). The GENUD Research Group was co-financed by the European Regional Development Fund (MICINN-FEDER).