Department of Medicine, Veterans Affairs Medical Center, Washington, DC; Department of Medicine, George Washington University School of Medicine, Washington, DC.
Am J Cardiol. 2013 Nov 15;112(10):1605-9. doi: 10.1016/j.amjcard.2013.07.042. Epub 2013 Sep 13.
Heart rate (HR) at rest has been associated inversely with mortality risk. However, fitness is inversely associated with mortality risk and both increased fitness and β-blockade therapy affect HR at rest. Thus, both fitness and β-blockade therapy should be considered when HR at rest-mortality risk association is assessed. From 1986 to 2011, we assessed HR at rest, fitness, and mortality in 18,462 veterans (mean age = 58 ± 11 years) undergoing a stress test. During a median follow-up period of 10 years (211,398 person-years), 5,100 died, at an average annual mortality of 24.1 events/1,000 person-years. After adjusting for age, body mass index, cardiac risk factors, medication, and exercise capacity, we noted approximately 11% increase in risk for each 10 heart beats. To assess the risk in a wide and clinically relevant spectrum, we established 6 HR at rest categories per 10 heart beat intervals ranging from <60 to ≥100 beats. Mortality risk was significantly elevated at a HR at rest of ≥70 beats/min (hazard ratio 1.14, confidence interval 1.04 to 1.25; p <0.006) and increased progressively to 49% (hazard ratio 1.49, confidence interval 1.29 to 1.73; p <0.001) for those with a HR at rest of ≥100 beats/min. Similar trends were noted when for subjects aged <60 and ≥60 years and those treated with β blockers. In all assessments, mortality risk was consistently overestimated when fitness was not considered. In conclusion, HR at rest-mortality risk association was direct and independent. A progressive increase in risk was noted >70 beats/min for the entire cohort, those treated with β blockers, and those aged <60 and ≥60 years. Mortality risk was overestimated slightly when fitness status was not considered.
静息心率（HR）与死亡率呈负相关。然而，健康水平与死亡率呈负相关，并且健康水平的提高和β受体阻滞剂治疗都会影响静息心率。因此，在评估静息心率与死亡率风险的关联时，应同时考虑健康水平和β受体阻滞剂治疗。 我们在 1986 年至 2011 年间，评估了 18462 名接受压力测试的退伍军人的静息心率、健康水平和死亡率。在中位数为 10 年（211398 人年）的随访期间，有 5100 人死亡，平均每年每 1000 人有 24.1 例死亡。在调整年龄、体重指数、心脏危险因素、药物和运动能力后，我们发现每增加 10 次心跳，风险大约增加 11%。为了在广泛且具有临床意义的范围内评估风险，我们根据每 10 次心跳间隔建立了 6 个静息心率类别，范围从<60 到≥100 次/分。静息心率≥70 次/分（危险比 1.14，95%置信区间 1.04 至 1.25；p<0.006）时死亡率风险显著升高，并且逐渐增加到 49%（危险比 1.49，95%置信区间 1.29 至 1.73；p<0.001）对于静息心率≥100 次/分的患者。当考虑年龄<60 岁和≥60 岁以及接受β受体阻滞剂治疗的患者时，也观察到类似的趋势。在所有评估中，当不考虑健康水平时，死亡率风险的估计值始终偏高。 综上所述，静息心率与死亡率风险之间存在直接且独立的关联。对于整个队列、接受β受体阻滞剂治疗的患者以及年龄<60 岁和≥60 岁的患者，当静息心率>70 次/分时，风险呈递增趋势。当不考虑健康状况时，死亡率风险的估计值略有偏高。
