Objective To investigate the relationship between resting heart rate and the detection rate of carotid plaques in individuals at high risk for cardiovascular disease (CVD) in Nanjing city, Jiangsu province, and to provide a reference for reducing the risk of CVD events in this population.

Methods From January 2020 to December 2021, a multi-stage stratified cluster random sampling method was used to select 38 488 permanent residents aged 35 - 79 years from Jianye district, Pukou district, Lishui district, Gaochun district, and Jiangbei New Area in Nanjing city. Participants underwent questionnaires, physical examinations, laboratory tests, and carotid ultrasound examinations to screen for high CVD risk. The 8 905 individuals identified as high-risk for CVD were divided into five groups based on their resting heart rate: ≤ 60, 61 - 70, 71 - 80, 81 - 90, and ≥ 91 beats/min. The detection rates of carotid plaques were compared among the different resting heart rate groups. Multivariable unconditional logistic regression models were used to analyze the relationship between resting heart rate and carotid plaque detection.

Results The detection rate of carotid plaques in the 8 905 high-risk CVD individuals in Nanjing city was 39.97%. The detection rates in men and women were 42.99% and 36.25%, respectively, with a statistically significant difference (χ² = 41.81, P < 0.001). The detection rates of carotid plaques in the high-risk CVD individuals with resting heart rates of ≤ 60, 61 - 70, 71 - 80, 81 - 90, and ≥ 91 beats/min were 39.65%, 35.37%, 38.56%, 39.77%, and 49.80%, respectively. In men, the corresponding rates were 42.64%, 37.62%, 40.07%, 43.16%, and 54.00%, and in women, they were 36.50%, 32.77%, 36.71%, 35.28%, and 42.16%. Statistically significant differences were observed in the detection rates of carotid plaques among different resting heart rate groups in both the overall high-risk CVD population and in men and women separately (all P < 0.05). After adjusting for confounding factors including sex, age, education level, marital status, smoking status, alcohol consumption, hypertension, diabetes, dyslipidemia, body mass index, and central obesity, multivariable unconditional logistic regression analysis showed that individuals with a resting heart rate ≥ 91 beats/min had a 1.26-fold higher risk of carotid plaque detection compared to those with a resting heart rate ≤ 60 beats/min (OR = 1.26, 95%CI: 1.07 - 1.68). After adjusting for age, education level, marital status, smoking status, alcohol consumption, hypertension, diabetes, dyslipidemia, body mass index, and central obesity, multivariable unconditional logistic regression analysis showed that men with a resting heart rate ≥ 91 beats/min had a 1.62-fold higher risk of carotid plaque detection compared to men with a resting heart rate ≤60 beats/min (OR = 1.62, 95%CI: 1.16 - 2.18).

Conclusions The detection rate of carotid plaques is high in the high-risk CVD population in Nanjing city. A resting heart rate ≥ 91 beats/min is an independent risk factor for carotid plaque detection in high-risk CVD individuals, especially men.