Shaper A G, Wannamethee G, Macfarlane P W, Walker M
Department of Public Health and Primary Care, Royal Free Hospital School of Medicine, London.
Br Heart J. 1993 Jul;70(1):49-55. doi: 10.1136/hrt.70.1.49.
To examine the relation between resting heart rate and new major ischaemic heart disease events in middle aged men with and without pre-existing ischaemic heart disease.
Prospective study of a cohort of men with eight years follow up for cardiovascular morbidity and mortality for all men.
General practices in 24 British towns (the British Regional Heart study).
7735 men aged 40-59 years drawn at random from the age-sex registers of one general practice in each town.
Major ischaemic heart disease events such as sudden cardiac death, other deaths attributed to ischaemic heart disease, and non-fatal myocardial infarction.
During the follow up period of eight years, 488 men had a major ischaemic heart disease event (217 fatal and 271 non-fatal). Of these, 117 were classified as sudden cardiac death (death within one hour of the start of symptoms). The relation between heart rate and risk of all major ischaemic heart disease events, ischaemic heart disease deaths, and sudden cardiac death was examined separately in men with and without pre-existing ischaemic heart disease. In men with no evidence of ischaemic heart disease, there was a strong positive association between resting heart rate and age adjusted rates of all major ischaemic heart disease events (fatal and non-fatal), ischaemic heart disease deaths, and sudden cardiac death. This association remained significant even after adjustment for age, systolic blood pressure, blood cholesterol, smoking, social class, heavy drinking, and physical activity, with particularly high risk in those with heart rate > or = 90 beats/min. The increased risk seen in those with increased heart rate was largely due to a significantly increased risk of sudden cardiac death, which was five times higher than in those with heart rate < 60 beats/min. The effect of heart rate on sudden cardiac death was present irrespective of blood pressure or smoking state. In men with pre-existing ischaemic heart disease a positive association was seen between raised heart rate and risk of all major ischaemic heart disease events, ischaemic heart disease death, and sudden cardiac death, but the effect was less noticeable than in men without pre-existing ischaemic heart disease.
In this study of middle aged British men increased heart rate > or = 90 beats/min) is a risk factor for fatal ischaemic heart disease events but particularly for sudden cardiac death. The effect is not dependent on the presence of other established coronary risk factors and is most clearly seen in men free of pre-existing ischaemic heart disease at initial examination.
研究静息心率与有无缺血性心脏病的中年男性发生新发主要缺血性心脏病事件之间的关系。
对一组男性进行前瞻性研究，随访8年，观察所有男性的心血管发病率和死亡率。
英国24个城镇的普通诊所（英国地区心脏研究）。
从每个城镇一家普通诊所的年龄-性别登记册中随机抽取的7735名40-59岁男性。
主要缺血性心脏病事件，如心源性猝死、其他归因于缺血性心脏病的死亡以及非致命性心肌梗死。
在8年的随访期内，488名男性发生了主要缺血性心脏病事件（217例致命，271例非致命）。其中，117例被归类为心源性猝死（症状开始后1小时内死亡）。分别在有无缺血性心脏病的男性中研究了心率与所有主要缺血性心脏病事件、缺血性心脏病死亡和心源性猝死风险之间的关系。在无缺血性心脏病证据的男性中，静息心率与年龄调整后的所有主要缺血性心脏病事件（致命和非致命）、缺血性心脏病死亡和心源性猝死发生率之间存在强烈的正相关。即使在调整了年龄、收缩压、血胆固醇、吸烟、社会阶层、大量饮酒和体力活动后，这种相关性仍然显著，心率≥90次/分钟者风险尤其高。心率增加者风险增加主要是由于心源性猝死风险显著增加，比心率<60次/分钟者高出五倍。无论血压或吸烟状态如何，心率对心源性猝死均有影响。在已有缺血性心脏病的男性中，可以看到心率升高与所有主要缺血性心脏病事件、缺血性心脏病死亡和心源性猝死风险之间存在正相关，但这种影响不如无缺血性心脏病的男性明显。
在这项针对英国中年男性的研究中，心率增加（≥90次/分钟）是致命性缺血性心脏病事件的危险因素，尤其是心源性猝死的危险因素。这种影响不依赖于其他已确定的冠状动脉危险因素，在初次检查时无缺血性心脏病的男性中最为明显。
