静息心率、心率变异性与老年功能衰退
Resting heart rate, heart rate variability and functional decline in old age.
作者信息
Ogliari Giulia, Mahinrad Simin, Stott David J, Jukema J Wouter, Mooijaart Simon P, Macfarlane Peter W, Clark Elaine N, Kearney Patricia M, Westendorp Rudi G J, de Craen Anton J M, Sabayan Behnam
机构信息
Department of Gerontology and Geriatrics (Ogliari, Mahinrad, Mooijaart, Westendorp, de Craen, Sabayan), Leiden University Medical Center, Leiden, the Netherlands; Department of Clinical Sciences and Community Health (Ogliari), University of Milan, Milan, Italy; Academic Section of Geriatric Medicine (Stott), Faculty of Medicine, University of Glasgow, Glasgow, United Kingdom; Department of Cardiology (Jukema), Leiden University Medical Center, Leiden, the Netherlands; Institute for Evidence-Based Medicine in Old Age (Mooijaart), Leiden, the Netherlands; Institute of Cardiovascular and Medical Sciences (Macfarlane, Clark), University of Glasgow, Glasgow, United Kingdom; Department of Epidemiology and Public Health (Kearney), University College Cork, Cork, Ireland; Department of Public Health (Westendorp), University of Copenhagen, Copenhagen, Denmark; Department of Radiology (Sabayan), Leiden University Medical Center, Leiden, the Netherlands.
Department of Gerontology and Geriatrics (Ogliari, Mahinrad, Mooijaart, Westendorp, de Craen, Sabayan), Leiden University Medical Center, Leiden, the Netherlands; Department of Clinical Sciences and Community Health (Ogliari), University of Milan, Milan, Italy; Academic Section of Geriatric Medicine (Stott), Faculty of Medicine, University of Glasgow, Glasgow, United Kingdom; Department of Cardiology (Jukema), Leiden University Medical Center, Leiden, the Netherlands; Institute for Evidence-Based Medicine in Old Age (Mooijaart), Leiden, the Netherlands; Institute of Cardiovascular and Medical Sciences (Macfarlane, Clark), University of Glasgow, Glasgow, United Kingdom; Department of Epidemiology and Public Health (Kearney), University College Cork, Cork, Ireland; Department of Public Health (Westendorp), University of Copenhagen, Copenhagen, Denmark; Department of Radiology (Sabayan), Leiden University Medical Center, Leiden, the Netherlands
出版信息
CMAJ. 2015 Oct 20;187(15):E442-E449. doi: 10.1503/cmaj.150462. Epub 2015 Aug 31.
BACKGROUND
Heart rate and heart rate variability, markers of cardiac autonomic function, have been linked with cardiovascular disease. We investigated whether heart rate and heart rate variability are associated with functional status in older adults, independent of cardiovascular disease.
METHODS
We obtained data from the Prospective Study of Pravastatin in the Elderly at Risk (PROSPER). A total of 5042 participants were included in the present study, and mean follow-up was 3.2 years. Heart rate and heart rate variability were derived from baseline 10-second electrocardiograms. Heart rate variability was defined as the standard deviation of normal-to-normal RR intervals (SDNN). Functional status in basic (ADL) and instrumental (IADL) activities of daily living was measured using Barthel and Lawton scales, at baseline and during follow-up.
RESULTS
The mean age of the study population was 75.3 years. At baseline, higher heart rate was associated with worse ADL and IADL, and lower SDNN was related to worse IADL (all p values < 0.05). Participants in the highest tertile of heart rate (range 71-117 beats/min) had a 1.79-fold (95% confidence interval [CI] 1.45-2.22) and 1.35-fold (95% CI 1.12-1.63) higher risk of decline in ADL and IADL, respectively (p for trend < 0.001 and 0.001, respectively). Participants in the lowest tertile of SDNN (range 1.70-13.30 ms) had 1.21-fold (95% CI 1.00-1.46) and 1.25-fold (95% CI 1.05-1.48) higher risk of decline in ADL and IADL, respectively (both p for trends < 0.05). All associations were independent of sex, medications, cardiovascular risk factors and comorbidities.
INTERPRETATION
Higher resting heart rate and lower heart rate variability were associated with worse functional status and with higher risk of future functional decline in older adults, independent of cardiovascular disease. This study provides insight into the role of cardiac autonomic function in the development of functional decline.
背景
心率和心率变异性作为心脏自主神经功能的标志物，已被证明与心血管疾病相关。我们研究了心率和心率变异性是否与老年人的功能状态相关，且独立于心血管疾病之外。
方法
我们从“老年高危人群普伐他汀前瞻性研究（PROSPER）”中获取数据。本研究共纳入5042名参与者，平均随访时间为3.2年。心率和心率变异性数据来自基线时的10秒心电图。心率变异性定义为正常RR间期的标准差（SDNN）。在基线和随访期间，使用巴氏量表和洛顿量表测量基本日常生活活动（ADL）和工具性日常生活活动（IADL）中的功能状态。
结果
研究人群的平均年龄为75.3岁。在基线时，较高的心率与较差的ADL和IADL相关，较低的SDNN与较差的IADL相关（所有p值均<0.05）。心率处于最高三分位数（范围为71 - 117次/分钟）的参与者，ADL和IADL下降的风险分别高出1.79倍（95%置信区间[CI] 1.45 - 2.22）和1.35倍（95% CI 1.12 - 1.63）（趋势p值分别<0.001和0.001）。SDNN处于最低三分位数（范围为1.70 - 13.30毫秒）的参与者，ADL和IADL下降的风险分别高出1.21倍（95% CI 1.00 - 1.46）和1.25倍（95% CI 1.05 - 1.48）（趋势p值均<0.05）。所有关联均独立于性别、药物、心血管危险因素和合并症。
解读
较高的静息心率和较低的心率变异性与老年人较差的功能状态以及未来功能下降的较高风险相关，且独立于心血管疾病。本研究为心脏自主神经功能在功能下降发展中的作用提供了见解。
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