Background:
Not all smokers are alike in their mortality risk. Heart rate is not routinely considered as a CVD or mortality risk when the rate is less than 100/min, and both smokers and doctors are unaware of any risk from normal heart rate.

Methods:
The cohort, 434,496, was recruited from participants in a health surveillance program between 1994 and 2008. Mortality was followed up by matching with National Death file. Resting heart rate was measured by EKG. Hazard ratios (HR) and life expectancy were calculated, based on the reference group of those with heart rates 60-69/min.

Results:
Smoking prevalence among male was 40.6% with 85,996 smokers in the cohort. Mortality risks increased incrementally with increasing heart rate from 70-79, 80-89, to ≥90. HR with high normal heart rate, 80-99/min, was 1.60 compared to smoker with 60-69/min and 2.69 compared to nonsmoker with 60-69/min.


[Mortality and life expectancy for smoker]



Conclusions:
Smokers with high normal heart rate, constituted nearly one fifth of smoking population, shortened life by 13 years compared to nonsmokers. Two out of three smokers in this group were expected to die from smoking related causes. Finding rapid heart rate among smokers could be used to further motivate smokers to quit, by sharing its high mortality risk.