静息心率对老年人群心脑血管事件及全因死亡的影响

Effects of resting heart rate on risk of cardiocerebral vascular diseases and all-cause mortality in the elderly

摘要:

目的 探讨老年人群(≥60岁)静息心率(RHR)水平对心脑血管事件及全因死亡的影响。方法 本前瞻性队列研究于2006年和2007年进行,参加者为101010名开滦集团的员工,选择其中年龄≥60岁、无心律失常、无心脑血管病史、未服用β受体阻滞剂的18924例职工为研究对象。按RHR四分位数值分为以下4组: <67次/min、68～71次/min、72～79次/min、≥80次/min。随访期间收集心脑血管疾病及全因死亡事件,应用Cox比例风险模型评估RHR与全因死亡及CVD的风险。结果 (1)中位随访11.18年,4组发生心脑血管事件例数和累积发病率分别为[536(11.32%)、479(12.38%)、686(12.53%)、618(12.76%)],差异无统计学意义(P>0.05)；4组发生全因死亡例数和累积全因死亡率分别为1086(22.93%)、940(24.30%)、1330(24.28%)、1462(30.19%)例,差异有统计学意义(P<0.01)。(2)校正传统心血管疾病危险因素后多因素分析显示,与RHR最低四分位数组相比,最高四分位组发生心脑血管事件及全因死亡的HR值分别为1.06(95%CI 0.93~1.20)、1.07(95%CI 0.95~1.20)、1.07(95%CI 0.94~1.21)；1.14(95%CI 1.04~1.25)、1.12(95%CI 1.03~1.22)、1.37(95%CI 1.26~1.49)。结论 RHR升高是开滦研究老年人群全因死亡的危险因素。

Abstract:

Objective To investigate the effects of resting heart rate (RHR) on cardiocerebral vascular diseases (CVD) and all-cause death in the elderly (≥60 years old). Methods This prospective cohort study was performed in 101 510 employees of Kailuan Group who received their first physical examination in 2006 and 2007. Included in the study were 18924 participants aged ≥60 years without arrhythmia, a history of CVD, and use of β-receptor blockers. According to the RHR quartile value, they were divided into four groups:<67 group, 68-71 group, 72-79 group, and ≥80 group (times/min). Data were collected of CVD and all-cause mortality events during follow-up period. Cox regression model was used to assess the association of RHR with all-cause mortality and CVD events. Results (1)During a median follow-up period of 11.18 years, the number and cumulative incidence of CVD events in the 4 groups were 536(11.32%) in <67 group, 479(12.38%) in 68-71 group, 686(12.53%) in 72-79 group, and 618(12.76%)≥80 group, with no statistical significance (P>0.05). The number of all-cause deaths and cumulative all-cause mortality in the 4 groups were 1086(22.93%), 940(24.30%), 1330(24.28%) and 1462(30.19%), respectively, with statistically significant differences (P<0.01). (2) In multivariate analysis adjusted for major conventional cardiovascular risk factors, compared with the lowest quartile group, CVD events and all-cause death in the highest quartile group were 1.06(95%CI:0.93-1.20), 1.07(95%CI:0.95-1.20), 1.07(95%CI:0.94-1.21); 1.14(95%CI:1.04-1.25), 1.12(95%CI:1.03-1.22), 1.37(95%CI:1.26-1.49), respectively. Conclusion Elevated RHR is a risk factor for all-cause mortality in the cohort of the elderly subjects of Kailuan Group.