Daily Heart Rate per Step: A Wearables Metric Associated With Cardiovascular Disease in a Cross‐Sectional Study of the All of Us Research Program

• DOI: 10.1161/jaha.124.036801
• Publication Date: 2025-03-29T15:00:28Z
• Authors: Zhanlin Chen; Charles T. Wang; Carolyn J. Hu; Kendra Ward; Abel Kho; Gregory Webster
• Keywords: Cross-sectional study; Cardiovascular Health

Simple biometrics such as peak heart rate and exercise duration remain core predictors of cardiovascular disease (CVD). Commercial wearable devices track physical 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 6,947 participants in the Fitbit Bring-Your-Own-Device Project, subset All Us Research Program. The primary exposure Daily Heart Rate Per Step (DHRPS) was defined average daily divided by steps per day. Our analysis correlated DHRPS established CVD (type 2 diabetes, hypertension, stroke, failure, coronary atherosclerosis, myocardial infarction) outcomes. We also performed DHRPS-based phenome-wide association (PheWAS) on spectrum human traits for all 1,789 codes across 17 categories. Secondary outcomes included maximum metabolic equivalents (METs) achieved treadmill stress testing. examined 5.8 million person-days 51 billion total individual-level paired electronic health record data. Elevated type diabetes (OR 2.03 [95% CI 1.70-2.42]), hypertension 1.63 1.32-2.02]), failure 1.77 1.00-3.14]), atherosclerosis 1.44 1.14-1.82]), even after adjusting step count. had stronger correlations max METs testing compared day (∆ρ=0.04, p<0.001) (∆ρ=0.31, p<0.001). Lastly, PheWAS demonstrated associations (p<1×10-55) or In Program an easy-to-calculate metric more strongly fitness than