Wang Yuebo, Yin Lu, Hu Bo, Tse Lap Ah, Liu Yu, Ma Haibin, Li Wei
State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
Clinical Research Service Center, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, China.
Ann Transl Med. 2021 Jun;9(11):917. doi: 10.21037/atm-21-706.
Cardiovascular disease is the leading cause of death worldwide. We assessed the association of baseline heart rate with cardiovascular events and mortality in hypertensive and normotensive populations using a prospective urban and rural epidemiology cohort study in China.
A total of 29,554 individuals were involved in our analysis, distributed equally between groups of normotensive and hypertensive. The primary outcomes were myocardial infarction, stroke, major cardiovascular diseases, and cardiovascular mortality. Cox frailty models were utilized to estimate hazard ratios for cardiovascular outcomes, and restricted cubic splines were used to explore the shape of the association between baseline heart rate and cardiovascular mortality.
During a total observational time of 230,813 person-years, 402 myocardial infarction events, 1,096 stroke events, 1,540 major cardiovascular events, and 356 cardiovascular deaths were documented. In adjusted analyses, normotensive subjects with baseline heart rate >82.5 beats per minute had a 3.30-fold greater risk of cardiovascular death and an increased 72% risk of myocardial infarction, compared with individuals whose baseline heart rate was 65.5-71 beats per minute. A similar trend was observed for cardiovascular mortality in the hypertensive population, but the association was attenuated. Multivariable-adjusted restricted cubic splines showed linear associations between baseline heart rate and cardiovascular mortality in two groups of people (all P<0.05 for linearity).
Elevated baseline heart rate is associated with an increased risk of cardiovascular mortality and myocardial infarction in the normotensive population. The association is attenuated for cardiovascular death in hypertensive patients.
心血管疾病是全球主要的死亡原因。我们利用中国一项前瞻性城乡流行病学队列研究，评估了高血压人群和血压正常人群中基线心率与心血管事件及死亡率之间的关联。
共有29554人参与我们的分析，在血压正常组和高血压组中平均分配。主要结局为心肌梗死、中风、主要心血管疾病和心血管死亡。采用Cox脆弱模型估计心血管结局的风险比，并使用受限立方样条来探究基线心率与心血管死亡率之间关联的形状。
在总计230813人年的观察期内，记录到402例心肌梗死事件、1096例中风事件、1540例主要心血管事件和356例心血管死亡。在调整分析中，与基线心率为65.5 - 71次/分钟的个体相比，基线心率>82.5次/分钟的血压正常受试者心血管死亡风险高3.30倍，心肌梗死风险增加72%。在高血压人群中观察到类似的心血管死亡率趋势，但该关联有所减弱。多变量调整后的受限立方样条显示两组人群中基线心率与心血管死亡率之间呈线性关联（线性检验P均<0.05）。
在血压正常人群中，基线心率升高与心血管死亡率和心肌梗死风险增加相关。在高血压患者中，该关联对心血管死亡有所减弱。
