Aune D, Sen A, ó'Hartaigh B, Janszky I, Romundstad P R, Tonstad S, Vatten L J
Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Department of Epidemiology and Public Health, Imperial College, London, UK; Bjørknes University College, Oslo, Norway.
Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
Nutr Metab Cardiovasc Dis. 2017 Jun;27(6):504-517. doi: 10.1016/j.numecd.2017.04.004. Epub 2017 Apr 21.
Epidemiological studies have reported increased risk of cardiovascular disease, cancer and all-cause mortality with greater resting heart rate, however, the evidence is not consistent. Differences by gender, adjustment for confounding factors, as well as the potential impact of subclinical disease are not clear. A previous meta-analysis missed a large number of studies, and data for atrial fibrillation have not been summarized before. We therefore aimed to clarify these associations in a systematic review and meta-analysis of prospective studies.
PubMed and Embase were searched up to 29 March 2017. Summary RRs and 95% confidence intervals (CIs) were calculated using random effects models. Eighty seven studies were included. The summary RR per 10 beats per minute increase in resting heart rate was 1.07 (95% CI: 1.05-1.10, I = 61.9%, n = 31) for coronary heart disease, 1.09 (95% CI: 1.00-1.18, I = 62.3%, n = 5) for sudden cardiac death, 1.18 (95% CI: 1.10-1.27, I = 74.5%, n = 8) for heart failure, 0.97 (95% CI: 0.92-1.02, I = 91.4%, n = 9) for atrial fibrillation, 1.06 (95% CI: 1.02-1.10, I = 59.5%, n = 16) for total stroke, 1.15 (95% CI: 1.11-1.18, I = 84.3%, n = 35) for cardiovascular disease, 1.14 (95% CI: 1.06-1.23, I = 90.2%, n = 12) for total cancer, and 1.17 (95% CI: 1.14-1.19, I = 94.0%, n = 48) for all-cause mortality. There was a positive dose-response relationship for all outcomes except for atrial fibrillation for which there was a J-shaped association.
This meta-analysis found an increased risk of coronary heart disease, sudden cardiac death, heart failure, atrial fibrillation, stroke, cardiovascular disease, total cancer and all-cause mortality with greater resting heart rate.
流行病学研究报告称，静息心率越高，患心血管疾病、癌症及全因死亡率的风险越高，然而，证据并不一致。性别差异、混杂因素的调整以及亚临床疾病的潜在影响尚不清楚。之前的一项荟萃分析遗漏了大量研究，且此前尚未对心房颤动的数据进行总结。因此，我们旨在通过对前瞻性研究的系统评价和荟萃分析来阐明这些关联。
检索截至2017年3月29日的PubMed和Embase数据库。使用随机效应模型计算汇总相对危险度（RR）和95%置信区间（CI）。纳入87项研究。静息心率每增加10次/分钟，冠心病的汇总RR为1.07（95%CI：1.05 - 1.10，I² = 61.9%，n = 31），心源性猝死的汇总RR为1.09（95%CI：1.00 - 1.18，I² = 62.3%，n = 5），心力衰竭的汇总RR为1.18（95%CI：1.10 - 1.27，I² = 74.5%，n = 8），心房颤动的汇总RR为0.97（95%CI：0.92 - 1.02，I² = 91.4%，n = 9），总卒中的汇总RR为1.06（95%CI：1.02 - 1.10，I² = 59.5%，n = 16），心血管疾病的汇总RR为1.15（95%CI：1.11 - 1.18，I² = 84.3%，n = 35），总癌症的汇总RR为1.14（95%CI：1.06 - 1.23，I² = 90.2%，n = 12），全因死亡率的汇总RR为1.17（95%CI：1.14 - 1.19，I² = 94.0%，n = 48）。除心房颤动呈J形关联外，所有结局均存在正剂量反应关系。
这项荟萃分析发现，静息心率越高，患冠心病、心源性猝死、心力衰竭、心房颤动、卒中、心血管疾病、总癌症及全因死亡率的风险越高。
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