Lonn Eva M, Rambihar Sherryn, Gao Peggy, Custodis Florian F, Sliwa Karen, Teo Koon K, Yusuf Salim, Böhm Michael
Division of Cardiology, Department of Medicine, McMaster University, Hamilton, ON, Canada.
Clin Res Cardiol. 2014 Feb;103(2):149-59. doi: 10.1007/s00392-013-0644-4. Epub 2013 Dec 20.
Heart rate was proposed as an emergent cardiovascular (CV) risk factor. Previous studies have shown associations between increased heart rate and CV risk in various populations. We aimed to evaluate the prognostic relevance of heart rate in a large contemporaneous medically optimized cohort of patients with stable chronic CV disease.
In a post hoc analysis of the ONTARGET/TRANSCEND trials, we evaluated associations between baseline and average heart rate in trial with CV risk in 31, 531 patients followed for a median of 5 years. The primary outcome, major vascular events (MVE), was a composite of CV death, myocardial infarction (MI), stroke, and congestive heart failure (CHF). Pre-specified secondary outcomes included all-cause death and the individual components of the primary outcome. Associations between heart rate and outcomes were computed with heart rate as a continuous variable, baseline heart rate >70 vs ≤ 70 bpm, and across heart rate quintiles, adjusting for other markers of risk, beta-blocker and non-dihydropyridine calcium channel blocker use. For each 10 bpm increase in baseline and average heart rate, we observed a significant increase in risk of MVE, CV death, CHF and all-cause death. There was a continuous relationship between MVE and baseline and, more importantly, average in-trial heart rate, with no observed threshold. MVE, CV death, stroke, CHF, and all-cause death increased across heart rate quintiles. There was no association between MI and HR. Results were consistent in clinically relevant subgroups. There were modest but significant improvements in C-statistic and in statistical measures of model calibration for models that included heart rate for MVE, CV death, CHF and all-cause death.
This large study examined and quantitated associations between heart rate and CV events in a contemporary medically optimized population with stable CV disease. Resting and, in particular, in-trial average heart rate are independently associated with significant increases in CV events and all-cause death.
心率被认为是一种新出现的心血管（CV）危险因素。既往研究已表明，在不同人群中，心率升高与心血管风险之间存在关联。我们旨在评估心率在一个大型的、同时期接受最佳药物治疗的稳定慢性心血管疾病患者队列中的预后相关性。
在ONTARGET/TRANSCEND试验的一项事后分析中，我们评估了31531例患者（中位随访时间为5年）的试验基线心率和平均心率与心血管风险之间的关联。主要结局为重大血管事件（MVE），它是心血管死亡、心肌梗死（MI）、中风和充血性心力衰竭（CHF）的复合结局。预先设定的次要结局包括全因死亡以及主要结局的各个组成部分。心率与结局之间的关联通过将心率作为连续变量、基线心率>70与≤70次/分钟进行计算，并在心率五分位数范围内进行分析，同时对其他风险标志物、β受体阻滞剂和非二氢吡啶类钙通道阻滞剂的使用情况进行校正。基线心率和平均心率每增加10次/分钟，我们观察到MVE、心血管死亡、CHF和全因死亡风险显著增加。MVE与基线心率以及更重要的试验期间平均心率之间存在连续关系，未观察到阈值。MVE、心血管死亡、中风、CHF和全因死亡在心率五分位数范围内均增加。MI与心率之间无关联。结果在临床相关亚组中一致。对于包含心率的MVE、心血管死亡、CHF和全因死亡模型，C统计量以及模型校准的统计指标有适度但显著的改善。
这项大型研究在一个当代接受最佳药物治疗的稳定心血管疾病人群中，研究并量化了心率与心血管事件之间的关联。静息心率，尤其是试验期间的平均心率，与心血管事件和全因死亡的显著增加独立相关。
