Chen Zhanlin, Wang Charles T, Hu Carolyn J, Ward Kendra, Kho Abel, Webster Gregory
Feinberg School of Medicine Northwestern University Chicago IL USA.
Division of Cardiology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago Northwestern University Feinberg School of Medicine Chicago IL USA.
J Am Heart Assoc. 2025 May 6;14(9):e036801. doi: 10.1161/JAHA.124.036801. Epub 2025 May 7.
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.
This cross-sectional study analyzed 6947 participants in the Fitbit Bring-Your-Own-Device 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-based phenome-wide 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-days and 51 billion total steps of individual-level Fitbit data paired with electronic health record data. Elevated DHRPS was associated with type 2 diabetes (odds ratio [OR], 2.03 [95% CI, 1.70-2.42]), hypertension (OR, 1.63 [95% CI, 1.32-2.02]), heart failure (OR, 1.77 [95% CI, 1.00-3.14]), and coronary atherosclerosis (OR, 1.44 [95% CI, 1.14-1.82]), 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 (∆ρ=0.04, <0.001) and heart rate (∆ρ=0.31, <0.001). Lastly, DHRPS-based phenome-wide association study demonstrated stronger associations with CVD factors (<1×10) compared with daily heart rate or step count.
In the All of Us Research Program Fitbit Bring-Your-Own-Device Project, DHRPS was an easy-to-calculate wearables metric and was more strongly associated with cardiovascular fitness and CVD outcomes than DHR and step count.
诸如心率峰值和运动时长等简单的生物特征指标仍然是心血管疾病（CVD）的核心预测因素。商用可穿戴设备可追踪身体活动和心脏电活动。从可穿戴设备收集详细的纵向数据为识别与心血管疾病相关的新因素提供了宝贵机会。
这项横断面研究分析了“我们所有人研究计划”的一个子集——Fitbit自带设备项目中的6947名参与者。主要暴露因素每日每步心率（DHRPS）定义为每日平均心率除以每日步数。我们的分析将DHRPS与既定的心血管疾病因素（2型糖尿病、高血压、中风、心力衰竭、冠状动脉粥样硬化、心肌梗死）作为主要结局进行关联。我们还针对17个疾病类别中的所有1789个疾病编码，对人类疾病特征谱进行了基于DHRPS的全表型关联研究。次要结局包括在心血管跑步机运动压力测试中达到的最大代谢当量。我们检查了580万人日以及与电子健康记录数据配对的个人层面Fitbit数据中的510亿总步数。即使在调整每日心率（DHR）和步数后，较高的DHRPS仍与2型糖尿病（比值比[OR]，2.03[95%置信区间，1.70 - 2.42]）、高血压（OR，1.63[95%置信区间，1.32 - 2.02]）、心力衰竭（OR，1.77[95%置信区间，1.00 - 3.14]）和冠状动脉粥样硬化（OR，1.44[95%置信区间，1.14 - 1.82]）相关。与每日步数（∆ρ = 0.04，<0.001）和心率（∆ρ = 0.31，<0.001）相比，DHRPS与运动压力测试中达到的最大代谢当量也具有更强相关性。最后，基于DHRPS的全表型关联研究表明，与每日心率或步数相比，其与心血管疾病因素的关联更强（<1×10）。
在“我们所有人研究计划”Fitbit自带设备项目中，DHRPS是一个易于计算的可穿戴设备指标，并且与心血管健康和心血管疾病结局的关联比DHR和步数更强。
