Background: Both resting heart rate (HR) and left ventricular hypertrophy (LVH) are associated with cardiovascular morbidity and mortality. Elevated HR is associated with left ventricular remodeling. The association between resting HR and developing electrocardiographic (ECG) LVH, however, is unclear. Methods: This was a retrospective cohort study based on data from a general health check-up performed by OGHMA. HR and LVH were evaluated, followed by ECG. The primary endpoint was the development of LVH diagnosed by a Sokolow-Lyon voltage greater than 38 mm. COX regression analysis was used to calculate the hazard ratios of the HR increase for developing LVH. Results: A total of 6860 subjects (4203 men, 2657 women, 48.7 [9.8] years of age) without LVH were followed for a mean duration of 3.8±1.4 years. Mean (SD) systolic blood pressure (SBP) and HR levels were 121 (17) mmHg and 66.5 (10.1) bpm, respectively, and 22% of the subjects were diagnosed with hypertension. A total of 484 subjects (7.1%) developed LVH during the follow-up period. COX regression analysis revealed that every 10-bpm mean HR increase was associated with a 27% decreased risk of developing LVH (95% confidence interval [CI]: 0.63 – 0.86) in men. In an alternative analysis, every 10-mmHg mean SBP increase was associated with 53% increased risk of developing LVH (95% CI: 1.40 - 1.67). In women, however, HR did not influence the risk of developing LVH. Every 10-mmHg mean SBP increase was associated with a 47% increased risk of developing LVH (95% CI: 1.28 – 1.69%). Adjusted hazar ratios for developing LVH Conclusion: Elevated resting HR was negatively associated with the development of ECG-LVH in a healthy male screened cohort.