Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland.
Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland.
Am J Cardiol. 2019 Jan 15;123(2):334-340. doi: 10.1016/j.amjcard.2018.10.013. Epub 2018 Oct 21.
Resting heart rate (RHR) is independently associated with cardiovascular disease (CVD) risk. We determined whether RHR, measured in mid-life, is also associated with cognitive decline. We studied 13,720 middle-aged white and black ARIC participants without a history of stroke or atrial fibrillation. RHR was obtained from a 12-lead resting electrocardiogram at the baseline visit (1990 to 1992) and categorized into groups as <60 (reference), 60 to 69, 70 to 79 and ≥80 beats/min. Cognitive scores were obtained at baseline and at up to 2 additional visits (1996 to 1998 and 2011 to 2013). The primary outcome was a global composite cognitive score (Z-score) derived from 3 tests: delayed word recall, digit symbol substitution, and word fluency. The associations of RHR with cognitive decline and incident dementia were examined using linear mixed-effects and Cox hazard models, respectively, adjusting for sociodemographics, CVD risk factors, and AV-nodal blockade use. Multiple imputation methods were used to account for attrition over follow-up. Participants had mean ± SD age of 58 ± 6 years; 56% were women, 24% black. Average RHR was 66 ± 10 beats/min. Over a mean follow-up of 20 years, those with RHR ≥80 beats/min had greater global cognitive decline (average adjusted Z-score difference -0.12 [95% confidence interval -0.21, -0.03]) and increased risk for incident dementia (hazard ratio 1.28 (1.04, 1.57), compared with those with RHR <60 beats/min. In conclusion, elevated RHR is independently associated with greater cognitive decline and incident dementia over 20 years. Further studies are needed to determine whether the associations are causal or secondary to another underlying process, and whether modification of RHR can affect cognitive decline.
静息心率（RHR）与心血管疾病（CVD）风险独立相关。我们确定了中年时期测量的 RHR 是否也与认知能力下降有关。我们研究了 13720 名没有中风或心房颤动病史的中年白人和黑人 ARIC 参与者。RHR 是在基线（1990 年至 1992 年）时从 12 导联静息心电图中获得的，并分为<60（参考）、60 至 69、70 至 79 和≥80 次/分。认知评分在基线时和最多 2 次随访（1996 年至 1998 年和 2011 年至 2013 年）获得。主要结局是来自 3 项测试的全球综合认知评分（Z 评分）：延迟单词回忆、数字符号替代和单词流畅性。使用线性混合效应和 Cox 风险模型分别检查 RHR 与认知能力下降和痴呆症发病的关系，调整了社会人口统计学、CVD 风险因素和房室结阻滞的使用。采用多重插补方法考虑随访期间的缺失。参与者的平均年龄为 58±6 岁；56%为女性，24%为黑人。平均 RHR 为 66±10 次/分。在平均 20 年的随访中，RHR≥80 次/分的人认知功能下降更明显（平均调整 Z 评分差异-0.12[95%置信区间-0.21，-0.03]），且痴呆症发病风险增加（风险比 1.28[1.04，1.57]），与 RHR<60 次/分的人相比。总之，静息心率升高与 20 年内认知能力下降和痴呆症发病独立相关。需要进一步的研究来确定这些关联是因果关系还是继发于另一个潜在过程，以及是否可以通过改变 RHR 来影响认知能力下降。
