Department of Molecular and Clinical Medicine, University of Gothenburg, Goteborg, Sweden
Department of Cardiology, Sahlgrenska University Hospital, Goteborg, Sweden.
Open Heart. 2023 Jul;10(2). doi: 10.1136/openhrt-2023-002307.
This study aimed to examine the association between exercise workload, resting heart rate (RHR), maximum heart rate and the risk of developing ST-segment elevation myocardial infarction (STEMI).
The study included all participants from the UK Biobank who had undergone submaximal exercise stress testing. Patients with a history of STEMI were excluded. The allowed exercise load for each participant was calculated based on clinical characteristics and risk categories. We studied the participants who exercised to reach 50% or 35% of their expected maximum exercise tolerance. STEMI was adjudicated by the UK Biobank. We used Cox regression analysis to study how exercise tolerance and RHR were related to the risk of STEMI.
A total of 66 949 participants were studied, of whom 274 developed STEMI during a median follow-up of 7.7 years. After adjusting for age, sex, blood pressure, smoking, forced vital capacity, forced expiratory volume in 1 s, peak expiratory flow and diabetes, we noted a significant association between RHR and the risk of STEMI (p=0.015). The HR for STEMI in the highest RHR quartile (>90 beats/min) compared with that in the lowest quartile was 2.92 (95% CI 1.26 to 6.77). Neither the maximum achieved exercise load nor the ratio of the maximum heart rate to the maximum load was significantly associated with the risk of STEMI. However, a non-significant but stepwise inverse association was noted between the maximum load and the risk of STEMI.
RHR is an independent predictor of future STEMI. An RHR of >90 beats/min is associated with an almost threefold increase in the risk of STEMI.
本研究旨在探讨运动工作量、静息心率（RHR）、最大心率与发生 ST 段抬高型心肌梗死（STEMI）风险之间的关系。
本研究纳入了所有在英国生物库接受亚极量运动压力测试的参与者。排除有 STEMI 病史的患者。根据临床特征和风险类别计算每位参与者的允许运动负荷。我们研究了达到预期最大运动耐力 50%或 35%的参与者。STEMI 通过英国生物库进行裁决。我们使用 Cox 回归分析研究运动耐力和 RHR 与 STEMI 风险之间的关系。
共研究了 66949 名参与者，其中 274 名在中位随访 7.7 年内发生 STEMI。在校正年龄、性别、血压、吸烟、用力肺活量、1 秒用力呼气量、呼气峰流速和糖尿病后，我们注意到 RHR 与 STEMI 风险之间存在显著关联（p=0.015）。最高 RHR 四分位（>90 次/分）与最低四分位相比，STEMI 的 HR 为 2.92（95%CI 1.26 至 6.77）。最大运动负荷或最大心率与最大负荷的比值与 STEMI 风险均无显著相关性。然而，我们观察到最大负荷与 STEMI 风险之间存在非显著但呈逐步负相关关系。
RHR 是未来 STEMI 的独立预测指标。RHR>90 次/分与 STEMI 风险增加近三倍相关。
