Perret-Guillaume Christine, Joly Laure, Benetos Athanase
Department of Geriatrics, University Hospital of Nancy, Vandoeuvre-les-Nancy, France.
Prog Cardiovasc Dis. 2009 Jul-Aug;52(1):6-10. doi: 10.1016/j.pcad.2009.05.003.
Almost all the epidemiological studies that aimed to answer the question of the relationship between heart rate and all-cause or cardiovascular morbidity and mortality reported that a high heart rate was associated with a higher risk of all-cause mortality and cardiovascular events. This relationship has been found to be generally stronger in men than among women. The increase in the cardiovascular risk, associated with the acceleration of heart rate, was comparable to the increase in risk observed with high blood pressure. It has been shown that an increase in heart rate by 10 beats per minute was associated with an increase in the risk of cardiac death by at least 20%, and this increase in the risk is similar to the one observed with an increase in systolic blood pressure by 10 mm Hg. It has also been shown that heart rate recorded in elderly men has a strong predictive value in survival to a very old age. Taken together, these results indicate that the risk associated with accelerated heart rate is not only statistical significant but also clinically relevant and that it should be taken into account in the evaluation of the patients. Although the association between elevated heart rate and cardiovascular morbidity and mortality has been demonstrated in a large number of epidemiological studies, tachycardia has remained a neglected cardiovascular risk factor until very recently. For the first time, the recent guidelines of the European Society of Cardiology and the European Society of Hypertension indicate than an accelerated heart rate is considered as an independent risk factor and potentially as a target for pharmacologic therapies, especially in high-risk patients.
几乎所有旨在回答心率与全因或心血管疾病发病率及死亡率之间关系问题的流行病学研究均报告称，心率较高与全因死亡率及心血管事件风险较高相关。人们发现这种关系在男性中通常比在女性中更为显著。与心率加快相关的心血管风险增加幅度，与高血压所观察到的风险增加幅度相当。研究表明，心率每分钟增加10次与心脏死亡风险至少增加20%相关，且这种风险增加与收缩压升高10毫米汞柱时所观察到的情况相似。研究还表明，老年男性记录的心率对活到高龄具有很强的预测价值。综合来看，这些结果表明，与心率加快相关的风险不仅在统计学上具有显著性，而且在临床上也具有相关性，在评估患者时应予以考虑。尽管心率升高与心血管疾病发病率及死亡率之间的关联已在大量流行病学研究中得到证实，但直到最近，心动过速一直是一个被忽视的心血管危险因素。欧洲心脏病学会和欧洲高血压学会最近的指南首次指出，心率加快被视为一个独立危险因素，并且可能成为药物治疗的靶点，尤其是在高危患者中。
