Saint Agnes Healthcare, Baltimore, MD, USA.
Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA.
Atherosclerosis. 2018 Jun;273:45-52. doi: 10.1016/j.atherosclerosis.2018.04.004. Epub 2018 Apr 6.
Left-sided valvular calcification is associated with cardiovascular disease (CVD) morbidity and mortality. Resting heart rate (RHR) may influence valvular calcium progression through shear stress. Whether RHR, an established CVD risk factor, is associated with valvular calcium progression is unknown. We assessed whether RHR predicts incidence and progression of mitral annular calcium (MAC) and aortic valve calcium (AVC) in a community-based cohort free of CVD at baseline.
RHR was obtained from baseline electrocardiograms of 5498 MESA participants. MAC and AVC were quantified using Agatston scoring from cardiac computed tomography scans obtained at baseline and at a second examination during follow-up. We examined associations of RHR with incident MAC/AVC and annual change in MAC/AVC scores, after adjusting for demographics, CVD risk factors, physical activity, and atrioventricular nodal blocker use.
At baseline, participants had mean age of 62 ± 10 years and mean RHR of 63 ± 10 bpm; 12.3% and 8.9% had prevalent AVC and MAC, respectively. Over a median of 2.3 years, 4.1% and 4.5% developed incident AVC and MAC, respectively. Each 10 bpm higher RHR was significantly associated with incident MAC [Risk Ratio 1.17 (95% CI 1.03-1.34)], but not incident AVC. However, RHR was associated with AVC progression [β = 1.62 (0.45-2.80) Agatston units/year for every 10 bpm increment], but not MAC progression.
Higher RHR was associated with MAC incidence and AVC progression, independent of traditional CVD risk factors. Future studies are needed to determine whether modification of RHR through lifestyle or pharmacologic interventions can reduce valvular calcium incidence or progression.
左心瓣膜钙化与心血管疾病（CVD）发病率和死亡率相关。静息心率（RHR）可能通过剪切力影响瓣膜钙的进展。RHR 是否与瓣膜钙进展相关，而 RHR 是已确立的 CVD 风险因素，目前尚不清楚。我们评估了 RHR 是否可预测基线时无 CVD 的社区队列中二尖瓣环钙（MAC）和主动脉瓣钙（AVC）的发生率和进展情况。
从 5498 名 MESA 参与者的基线心电图中获取 RHR。使用基线和随访期间的第二次心脏计算机断层扫描（CT）检查中的 Agatston 评分来量化 MAC 和 AVC。我们调整了人口统计学、CVD 风险因素、体力活动和房室结阻滞剂的使用后，检查了 RHR 与 MAC/AVC 新发事件和 MAC/AVC 评分的年变化之间的关联。
基线时，参与者的平均年龄为 62±10 岁，平均 RHR 为 63±10 bpm；分别有 12.3%和 8.9%的人存在先前的 AVC 和 MAC。在中位数为 2.3 年的随访期间，分别有 4.1%和 4.5%的人新发 AVC 和 MAC。RHR 每增加 10 bpm，MAC 新发事件的风险比为 1.17（95%CI 1.03-1.34），具有显著统计学意义，但与 AVC 新发事件无关。然而，RHR 与 AVC 进展相关（每增加 10 bpm，Agatston 单位增加 1.62（0.45-2.80）），但与 MAC 进展无关。
较高的 RHR 与 MAC 发生率和 AVC 进展相关，独立于传统 CVD 风险因素。需要进一步的研究来确定通过生活方式或药物干预来降低 RHR 是否可以降低瓣膜钙的发生率或进展。
