静息心率加快增加人群新发心力衰竭风险

A cohort study on the association between resting heart rate and the risk of new-onset heart failure

目的探讨静息心率加快对人群新发心力衰竭(心衰)的影响。方法该研究为前瞻性队列研究。选取参加了2006年度开滦集团公司职工健康体检且体检时完成心电图检查、静息心率数据完整者作为研究对象,排除患有心律失常者、服用β受体阻滞剂者以及有心衰病史者。根据静息心率将入选者进行五分位分组,即Q1、Q2、Q3、Q4、Q5组。收集入选者的一般临床资料及实验室检查结果。以新发心衰为终点事件。研究随访至2016年12月31日。采用多因素Cox回归模型分析不同静息心率组人群发生新发心衰的风险。结果研究最终入选88879人,年龄18~98(51.0±12.3)岁,其中男性68411人,静息心率(74±10)次/min。静息心率40~66次/min的人群归入Q1组(n=18168),静息心率67~70次/min的人群归入Q2组(n=18970),静息心率71~74次/min的人群归入Q3组(n=13583),静息心率75~80次/min的人群归入Q4组(n=22739),静息心率>80次/min的人群归入Q5组(n=15419)。5组人群年龄、性别、收缩压、舒张压、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、空腹血糖(FBG)、体重指数(BMI)、高敏C反应蛋白(hs-CRP)、教育程度、体育锻炼情况、吸烟情况、饮酒情况、糖尿病病史、高血压病史、服用降压药物情况差异均有统计学差异(P均<0.01),并且随着心率加快,有糖尿病病史、高血压病史者比例以及收缩压、舒张压、FBG水平依次升高(P均<0.01)。平均随访9.5年,Q1、Q2、Q3、Q4、Q5组人群新发心衰发病率分别为1.60%(290/18168)、1.36%(258/18970)、1.80%(245/13583)、1.76%(400/22739)、2.35%(362/15419),组间差异有统计学意义(P<0.01);人年发病率依次为1.7/千人年、1.5/千人年、1.9/千人年、1.9/千人年、2.6/千人年。校正了主要传统心血管危险因素后多因素Cox回归分析结果显示,与Q2组相比,Q3、Q4组、Q5组人群新发心衰的HR分别为1.23(95%CI 1.03~1.48,P<0.05)、1.19(95%CI 1.01~1.41,P<0.05)、1.39(95%CI 1.18~1.65,P<0.01)。除外了高血压患者、糖尿病患者、吸烟者以及随访期间发生急性心肌梗死者后重复多因素Cox回归分析,结果显示与Q2组相比,Q5组人群新发心衰的HR为1.58(95%CI 1.02~2.45,P<0.05)。结论静息心率加快增加人群新发心衰风险。

Objective To prospectively explore the relationship between resting heart rate(RHR)and risk of new-onset heart failure.Methods It was a prospective cohort study.People who attended the physical examination of Kailuan Group Company in 2006 and with complete electrocardiography(ECG)recordings were eligible for this study.A total of 88879 participants aged 18 years old or more who were free of arrhythmia,a prior history of heart failure and were not treated withβ-blocker were included.Participants were divided into 5 groups according to the quintiles of RHR at baseline(Q1 group,40-60 beats/minutes(n=18168);Q2 group,67-70 beats/minutes(n=18970);Q3 group,71-74 beats/minutes(n=13583);Q4 group,75-80 beats/minutes(n=22739);and Q5 group,>80 beats/minutes(n=15419)).The general clinical data and laboratory test results were collected.The outcome was the first occurrence of heart failure at the end of follow-up(December 31,2016).We used Cox regression model to examine the association between RHR and the risk of new-onset heart failure.Hazard ratio(HR)with 95%confidence intervals(CI)were calculated using Cox regression modeling.Results Among the included patients 68411 participants were male,mean age was(51.0±12.3)years old,and RHR was(74±10)beats/minutes.Statistically significant differences among the RHR quintiles were found for the following variables:age,gender,systolic blood pressure,diastolic blood pressure,triglycerides,low-density lipoprotein cholesterol,high-density lipoprotein cholesterol,fasting blood glucose,body mass index,the level of high-sensitivity C-reactive protein,education status,physical activity,smoking status,drinking status,history of diabetes,history of hypertension and history of use antihypertensive drugs(all P<0.01).Higher RHR was linked with higher prevalence of diabetes,hypertension history,and higher systolic blood pressure,diastolic blood pressure and FBG levels(all P<0.01).After a mean follow-up of 9.5 years,the incidence of new-onset heart failure in Q1,Q2,Q3,Q4 and Q5 groups was 1.60%(290/18168),1.36%(258/18970),1.80%(245/13583),1.76%(400/22739)and 2.35%(362/15419),respectively(P<0.01).The person-year incidence of heart failure in Q1,Q2,Q3,Q4 and Q5 groups was 1.7,1.5,1.9,1.9 and 2.6 per 1000 person-years respectively.Compared with the Q2 group,multivariate analysis with adjustment for major traditional cardiovascular risk factors showed that HRs of Q3,Q4,and Q5 group were 1.23(95%CI 1.03-1.48,P<0.05),1.19(95%CI 1.01-1.41,P<0.05),1.39(95%CI 1.18-1.65,P<0.01),respectively.In the absence of hypertension,diabetes,smoking and acute myocardial infarction,the Cox regression model showed that compared with Q2 group,the HR of new-onset heart failure in Q5 group was 1.58(95%CI 1.02-2.45,P<0.05).Conclusion Increased RHR is associated with increased risk of new-onset heart failure in this cohort.