Beddhu Srinivasan, Nigwekar Sagar U, Ma Xilulian, Greene Tom
Department of Medicine, VA Healthcare System, University of Utah School of Medicine, Salt Lake City, UT, USA.
Nephrol Dial Transplant. 2009 Aug;24(8):2482-8. doi: 10.1093/ndt/gfp057. Epub 2009 Mar 22.
Insulin resistance is associated with increased sympathetic and reduced parasympathetic activity. Resting heart rate reflects autonomic activity. Therefore, we examined the associations of resting heart rate with insulin resistance, cardiovascular events and mortality in the moderate chronic kidney disease (CKD) population.
Four hundred and sixty participants with MDRD GFR <60 ml/min/1.73 m(2) in the limited access Atherosclerosis Risk in Communities (ARIC) study database were divided into four resting heart rate groups: <60, 60-74, 75-89 and >or=90/min. The prevalence of metabolic syndrome at baseline across the groups was examined. Time to cardiovascular composite (myocardial infarction or fatal coronary artery disease event or stroke or coronary revascularization procedure) and time to all-cause death were examined in multivariate Cox models.
The prevalence of metabolic syndrome in the <60, 60-74, 75-89 and >or=90/min groups were 41, 44, 69 and 82% (P < 0.001), respectively. In a multivariate Cox model adjusted for demographics, comorbidity, haemoglobin and physical activity, compared to the 60-74/min group, the hazard ratios of cardiovascular composite in <60, 75-89 and >or=90/min groups were 1.27 (95% CI 0.75-2.16), 1.79 (95% CI 1.07-2.99) and 1.37 (95% CI 0.54-3.44), respectively. In a similar model, the hazard ratios of death were 1.47 (95% CI 0.85-2.53), 3.11 (95% CI 1.93-5.02) and 3.97 (95% CI 1.99-7.94), respectively.
Resting heart rate is associated with metabolic syndrome in moderate CKD. Higher resting heart is associated with increased mortality and possibly cardiovascular events in this population. Interventional studies to examine whether a target resting heart rate of 60-74/min improves cardiovascular outcomes and survival in moderate CKD are warranted.
胰岛素抵抗与交感神经活动增加和副交感神经活动减少有关。静息心率反映自主神经活动。因此，我们研究了中度慢性肾脏病（CKD）人群中静息心率与胰岛素抵抗、心血管事件及死亡率之间的关联。
在社区动脉粥样硬化风险（ARIC）研究数据库中，将460名估算的肾小球滤过率（MDRD GFR）<60 ml/min/1.73 m²的参与者分为四个静息心率组：<60次/分钟、60 - 74次/分钟、75 - 89次/分钟和≥90次/分钟。检查各组基线时代谢综合征的患病率。在多变量Cox模型中研究心血管综合事件（心肌梗死或致命性冠状动脉疾病事件或中风或冠状动脉血运重建术）发生时间和全因死亡时间。
静息心率<60次/分钟、60 - 74次/分钟、75 - 89次/分钟和≥90次/分钟组代谢综合征的患病率分别为41%、44%、69%和82%（P<0.001）。在根据人口统计学、合并症、血红蛋白和体力活动进行校正的多变量Cox模型中，与60 - 74次/分钟组相比，静息心率<60次/分钟、75 - 89次/分钟和≥90次/分钟组心血管综合事件的风险比分别为1.27（95%CI 0.75 - 2.16）、1.79（95%CI 1.07 - 2.99）和1.37（95%CI 0.54 - 3.44）。在类似模型中，死亡风险比分别为1.47（95%CI 0.85 - 2.53）、3.11（95%CI 1.93 - 5.02）和3.97（95%CI 1.99 - 7.94）。
中度CKD患者的静息心率与代谢综合征有关。较高的静息心率与该人群死亡率增加及可能的心血管事件有关。有必要进行干预性研究，以检验静息心率目标为60 - 74次/分钟是否能改善中度CKD患者的心血管结局和生存率。
