切换至 "中华医学电子期刊资源库"

中华心脏与心律电子杂志 ›› 2023, Vol. 11 ›› Issue (01) : 5 -11. doi: 10.3877/cma.j.issn.2095-6568.2023.01.002

人工智能 大数据

静息心率对10年心血管疾病风险的影响
沈安娜1, 李建新1,(), 刘芳超1, 黄克勇1, 付真彦2, 鲁向锋1, 顾东风1   
  1. 1. 100037 北京,北京协和医学院 国家心血管病中心 中国医学科学院阜外医院流行病研究部 中国医学科学院心血管流行病学重点实验室
    2. 830000 乌鲁木齐,新疆医科大学第一附属医院心脏中心
  • 收稿日期:2023-01-31 出版日期:2023-03-25
  • 通信作者: 李建新
  • 基金资助:
    中国医学科学院医学与健康科技创新工程(2021-I2M-1-010,2019-I2M-2-003,2017-I2M-1-004); 国家重点研发计划(2017YFC0211700,2018YFE0115300,2021YFC2500605); 新疆科技支疆项目(2020E0278)

Association between resting heart rate and ten-year risk of cardiovascular disease in China

Anna Shen1, Jianxin Li1,(), Fangchao Liu1, Keyong Huang1, Zhenyan Fu2, Xiangfeng Lu1, Dongfeng Gu1   

  1. 1. Key Laboratory of Cardiovascular Epidemiology, Department of Epidemiology, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing 100037, China
    2. Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830000, China
  • Received:2023-01-31 Published:2023-03-25
  • Corresponding author: Jianxin Li
引用本文:

沈安娜, 李建新, 刘芳超, 黄克勇, 付真彦, 鲁向锋, 顾东风. 静息心率对10年心血管疾病风险的影响[J/OL]. 中华心脏与心律电子杂志, 2023, 11(01): 5-11.

Anna Shen, Jianxin Li, Fangchao Liu, Keyong Huang, Zhenyan Fu, Xiangfeng Lu, Dongfeng Gu. Association between resting heart rate and ten-year risk of cardiovascular disease in China[J/OL]. Chinese Journal of Heart and Heart Rhythm(Electronic Edition), 2023, 11(01): 5-11.

目的

探究静息心率与10年心血管疾病风险之间的关系,为心血管疾病的防治提供科学依据。

方法

本研究为横断面研究,研究对象来自中国动脉粥样硬化性心血管疾病风险预测研究(China-PAR)的基线调查,涉及全国15个省市18岁及以上人群117 309人。以静息心率60、70、80、90次/min作为切点,将其分为5组(<60次/min组、60~69次/min组、70~79次/min组、80~89次/min组和≥90次/min组),利用China-PAR模型计算研究对象10年心血管疾病风险,并以≥10%作为高风险人群,利用多因素Logistic回归模型,以10年心血管疾病高风险为终点,计算不同静息心率对其的比值比(OR)及其95%可信区间(CI)。

结果

性别、年龄调整后,10年心血管疾病风险水平随着静息心率的增加而增加,从静息心率<60次/min的2.31%上升至静息心率≥90次/min的2.67%,高风险人群的占比也从5.15%上升至7.09%。调整性别、年龄、文化程度、婚姻状况、职业、工作相关体力活动和家庭人均月收入后,静息心率每增加10次/min,出现10年心血管疾病高风险的概率升高9%(OR=1.09,95% CI 1.06~1.11)。以静息心率70~79次/min作为参照,静息心率80~89和≥90次/min人群中,出现高风险的概率分别升高至1.21(95% CI 1.14~1.29)倍和1.24(95% CI 1.14~1.35)倍。静息心率与10年心血管疾病的相关性在女性、城市人群、家庭人均月收入较高人群中更加明显,而在农民、中度及以上工作相关体力活动人群中相对较弱。

结论

静息心率与10年心血管疾病风险独立相关,可作为心血管疾病高危人群初筛和干预效果评价的简便易行的辅助指标,尤其是在女性、城市人群、较高收入人群和体力活动不足的人群中。

Objective

To evaluate the association between resting heart rate and ten-year risk of cardiovascular disease, and provide evidence for the prevention and treatment of cardiovascular disease.

Methods

This cross-sectional study was from the baseline survey of the Prediction for Atherosclerotic Cardiovascular Disease Risk in China (China-PAR), including 117 309 participants aged 18 years and above in 15 provinces in China. Participants were categorized into five groups (<60, 60-69, 70-79, 80-89, ≥90 beats/min) based on resting heart rates. The ten-year cardiovascular disease risks were estimated using the China-PAR equations, and those with ten-year risk ≥10% were identified as high-risk individuals. Odds ratios (OR) and 95% confidence intervals (CI) of high-risk for cardiovascular disease associated with resting heart rates were estimated using multivariate Logistic regression.

Results

Sex- and age-adjusted levels of ten-year cardiovascular disease risk increased with elevated resting heart rate, which increased from 2.31% among participants at resting heart rates <60 beats/min to 2.67% among those at ≥90 beats/min. Similar trend was observed for prevalence of high-risk, which climbed from 5.15% among individuals at <60 beats/min to 7.09% among those at ≥90 beats/min. After adjustment for sex, age, education, marital status, occupation, work-related physical activity, and household income per capita, an increment of 10 beats/min in resting heart rate was associated with a 9% increment in prevalence of high-risk for cardiovascular disease (OR=1.09, 95% CI 1.06-1.11). Compared with participants at resting heart rate 70-79 beats/min, those at 80-89 and ≥90 beats/min had ORs of 1.21 (95% CI 1.14-1.29) and 1.24 (95% CI 1.14-1.35), respectively. The association between resting heart rate and ten-year risk of cardiovascular disease was stronger in women, participants lived in urban and with higher monthly household income per capita, but weaker in farmers and population with moderate-heavy work-related physical activity.

Conclusion

Resting heart rate was independently associated with ten-year risk of cardiovascular disease. It could be used as a simple and auxiliary clinical indicator in pre-screening for high-risk population and evaluation for the effectiveness of cardiovascular disease interventions, particularly in women, population lived in urban, with higher income or with physical inactivity.

表1 117 309例不同静息心率人群的一般情况比较
特征变量 静息心率(次/min) F/χ2 P
<60 60~69 70~79 80~89 ≥90
例数 5 051 30 180 44 726 27 232 10 120
男性[例(%)] 3 253(64.40) 14 421(47.78) 17 464(39.05) 9 630(35.36) 3 539(34.97) 2 293.51 <0.001
年龄(岁,
x¯±s
53.46±11.97 51.42±11.60 50.46±11.81 49.88±12.21 49.97±13.12 139.69 <0.001
北方[例(%)] 2 418(47.87) 14 668(48.60) 22 022(49.24) 14 251(52.33) 4 924(48.66) 104.99 <0.001
城市[例(%)] 337(6.67) 3 728(12.35) 6 532(14.60) 4 096(15.04) 1 136(11.23) 382.79 <0.001
当前吸烟[例(%)] 1 820(36.03) 8 140(26.97) 10 163(22.72) 5 772(21.20) 2 015(19.91) 799.17 <0.001
高中及以上文化程度[例(%)] 626(12.42) 4 284(14.26) 7 083(15.91) 4 324(15.97) 1 542(15.34) 79.30 <0.001
婚姻状况[例(%)]
结婚/同居 4 624(91.75) 27 832(92.40) 41 173(92.23) 24 969(91.85) 9 036(89.51) 94.60 <0.001
未婚/分居/离婚/丧偶 416(8.25) 2 288(7.60) 3 470(7.77) 2 215(8.15) 1 059(10.49)
职业[例(%)]
管理/专业技术人员 414(8.88) 3 310(11.91) 5 256(12.96) 3 338(13.55) 1 077(12.01) 193.00 <0.001
工人 939(20.15) 5 585(20.10) 8 680(21.40) 5 294(21.49) 1 869(20.84)
农民 2 793(59.94) 15 871(57.11) 21 892(53.98) 13 078(53.08) 4 903(54.67)
其他 514(11.03) 3 025(10.88) 4 727(11.66) 2 929(11.89) 1 119(12.48)
中度及以上工作相关体力活动[例(%)] 3 113(61.85) 17 299(57.49) 23 984(53.79) 13 893(51.16) 4 995(49.49) 443.54 <0.001
家庭人均月收入≥800元[例(%)] 687(14.76) 3 725(13.89) 5 989(15.17) 3 206(13.87) 1 285(14.38) 30.09 <0.001
腰围(cm,
x¯±s
80.06±9.55 80.07±9.91 80.45±10.16 80.23±10.42 79.69±11.02 14.26 <0.001
收缩压(mmHg,
x¯±s
128.55±21.77 126.91±21.14 126.85±20.89 128.22±21.35 130.15±21.98 66.77 <0.001
舒张压(mmHg,
x¯±s
75.69±11.09 77.35±11.36 78.77±11.61 80.36±11.82 81.60±12.04 476.01 <0.001
2周内服用降压药[例(%)] 797(15.78) 3 810(12.62) 5 369(12.00) 3 254(11.95) 1 449(14.32) 98.17 <0.001
糖尿病[例(%)] 168(3.33) 1 091(3.61) 2 291(5.12) 1 917(7.04) 1 001(9.89) 762.36 <0.001
总胆固醇(mmol/L,
x¯±s
4.38±0.84 4.48±0.89 4.53±0.91 4.57±0.94 4.58±1.00 72.84 <0.001
高密度脂蛋白胆固醇(mmol/L,
x¯±s
1.32±0.33 1.32±0.33 1.31±0.33 1.32±0.33 1.33±0.34 5.61 <0.001
心血管疾病家族史[例(%)] 536(10.61) 3 315(10.98) 5 046(11.28) 3 224(11.84) 1 173(11.59) 14.00 0.007
图1 不同静息心率人群中,性别、年龄调整的10年心血管疾 病风险水平
表2 不同静息心率对10年心血管疾病高风险的影响比较
图2 不同亚组人群中静息心率(每增加10次/min)对10年心血管疾病高风险的影响a调整性别、年龄、文化程度、婚姻状况、职业、工作相关体力活动和家庭人均月收入
[1]
Zhou M, Wang H, Zeng X, et al. Mortality, morbidity, and risk factors in China and its provinces, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017[J]. Lancet, 2019, 394(10204):1145-1158.
[2]
GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019 [J]. Lancet, 2020, 396(10258): 1204-1222.
[3]
中华医学会心血管病学分会, 中国康复医学会心脏预防与康复专业委员会, 中国老年学和老年医学会心脏专业委员会, 等. 中国心血管病一级预防指南 [J]. 中华心血管病杂志, 2020, 48(12): 1000-1038.
[4]
Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines [J]. Circulation, 2019, 140(11): e596-e646.
[5]
Mao Q, Huang JF, Lu X, et al. Heart rate influence on incidence of cardiovascular disease among adults in China [J]. Int J Epidemiol, 2010, 39(6): 1638-1646.
[6]
Zhang D, Wang W, Li F. Association between resting heart rate and coronary artery disease, stroke, sudden death and noncardiovascular diseases: a meta-analysis [J]. CMAJ, 2016, 188(15): E384-E392.
[7]
Zhang D, Shen X, Qi X. Resting heart rate and all-cause and cardiovascular mortality in the general population: a meta-analysis [J]. CMAJ, 2016, 188(3): E53-E63.
[8]
Jing F Y, Wang X L, Song J L, et al. Association between clustering of cardiovascular risk factors and resting heart rate in Chinese population: a cross-sectional study [J]. J Geriatr Cardiol, 2022, 19(6): 418-427.
[9]
Yang X, Li J, Hu D, et al. Predicting the 10-year risks of atherosclerotic cardiovascular disease in Chinese Population: the China-PAR project (Prediction for ASCVD Risk in China) [J]. Circulation, 2016, 134(19): 1430-1440.
[10]
中国心血管病风险评估和管理指南编写联合委员会. 中国心血管病风险评估和管理指南 [J]. 中华预防医学杂志, 2019, 53(1): 13-35.
[11]
Wong GW, Wright JM. Blood pressure lowering efficacy of nonselective beta-blockers for primary hypertension [J]. Cochrane Database Syst Rev, 2014, (2): CD007452.
[12]
Wong G W, Laugerotte A, Wright JM. Blood pressure lowering efficacy of dual alpha and beta blockers for primary hypertension [J]. Cochrane Database Syst Rev, 2015, 2015(8): CD007449.
[13]
Wong GW, Boyda HN, Wright JM. Blood pressure lowering efficacy of beta-1 selective beta blockers for primary hypertension [J]. Cochrane Database Syst Rev, 2016, 3(3): CD007451.
[14]
Chen JM, Heran BS, Perez MI, et al. Blood pressure lowering efficacy of beta-blockers as second-line therapy for primary hypertension [J]. Cochrane Database Syst Rev, 2010, (1): CD007185.
[15]
Lee DH, de Rezende L, Hu FB, et al. Resting heart rate and risk of type 2 diabetes: a prospective cohort study and meta-analysis[J]. Diabetes Metab Res Rev, 2019, 35(2):e3095.
[16]
孙浩航, 牛振民, 赵阳, 等. 静息心率与高血压发病风险的关系及性别、年龄对其的修饰效应 [J]. 中华心血管病杂志, 2020, 48(1): 54-60.
[17]
Colangelo LA, Yano Y, Jacobs DR JR, et al. Association of resting heart rate with blood pressure and incident hypertension over 30 years in black and white adults: the CARDIA Study [J]. Hypertension, 2020, 76(3): 692-698.
[18]
Bønaa K H, Arnesen E. Association between heart rate and atherogenic blood lipid fractions in a population. The Tromsø Study [J]. Circulation, 1992, 86(2): 394-405.
[19]
许金鹏, 蒋钟吉, 廖碧红. 静息心率与心血管疾病关系研究进展 [J]. 内科, 2022, 17(2): 180-183.
[20]
Custodis F, Schirmer S H, Baumhäkel M, et al. Vascular pathophysiology in response to increased heart rate [J]. J Am Coll Cardiol, 2010, 56(24): 1973-1983.
[21]
St Pierre SR, Peirlinck M, Kuhl E. Sex matters: a comprehensive comparison of female and male hearts [J]. Front Physiol, 2022, 13: 831179.
[22]
Heiss HW, Barmeyer J, Wink K, et al. Studies on the regulation of myocardial blood flow in man. I.: Training effects on blood flow and metabolism of the healthy heart at rest and during standardized heavy exercise [J]. Basic Res Cardiol, 1976, 71(6): 658-675.
[1] 郝玥萦, 毛盈譞, 张羽, 汪佳旭, 韩林霖, 匡雯雯, 孟瑶, 杨秀华. 超声引导衰减参数成像评估肝脂肪变性及其对心血管疾病风险的预测价值[J/OL]. 中华医学超声杂志(电子版), 2024, 21(08): 770-777.
[2] 曹雯佳, 刘学兵, 罗安果, 钟释敏, 邓岚, 王玉琳, 李赵欢. 超声矢量血流成像对2型糖尿病患者颈动脉壁剪切应力的研究[J/OL]. 中华医学超声杂志(电子版), 2024, 21(07): 709-717.
[3] 陈晓玲, 钟永洌, 刘巧梨, 李娜, 张志奇, 廖威明, 黄桂武. 超高龄髋膝关节术后谵妄及心血管并发症风险预测[J/OL]. 中华关节外科杂志(电子版), 2024, 18(05): 575-584.
[4] 姚放鸣, 焦莹莹, 何敏聪, 曾子俊, 何晓铭, 刘良燕, 何伟, 魏秋实, 刘文刚. 膝骨关节炎患者的肌少症发病率及发病特点分析[J/OL]. 中华关节外科杂志(电子版), 2024, 18(01): 30-38.
[5] 王铭池, 梁乐琦, 刘永达. 基于NHANES数据库分析血脂与肾结石之间的关系[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(05): 485-490.
[6] 宋新雅, 苏小慧, 卞士柱, 丁小涵. 吸入性药物治疗肺动脉高压的研究进展[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(05): 831-835.
[7] 冯熔熔, 苏晓乐, 王利华. 慢性肾脏病患者并发心血管疾病相关生物标志物研究进展[J/OL]. 中华肾病研究电子杂志, 2024, 13(05): 273-278.
[8] 连奕豪, 易加祎, 张青. 视网膜血管迂曲度与心血管疾病危险因素相关性的研究进展[J/OL]. 中华眼科医学杂志(电子版), 2024, 14(02): 119-124.
[9] 孙秀芹, 高美娟, 张琼阁, 吕凯敏, 王宏宇. 京西地区无心血管病史2型糖尿病中老年人群患心血管疾病的危险因素分析[J/OL]. 中华临床医师杂志(电子版), 2024, 18(03): 245-252.
[10] 张洪, 王宏宇. 神经酰胺与心脏和血管疾病关系的研究进展[J/OL]. 中华临床医师杂志(电子版), 2023, 17(11): 1202-1205.
[11] 黄锦, 温静, 李佳霖, 韩丹, 刘翠华, 杨殿辉, 张洋洋. 双联抗血小板药物对溃疡性结肠炎患者的影响及处理策略[J/OL]. 中华胃肠内镜电子杂志, 2024, 11(03): 195-199.
[12] 易超, 陈庆伟. 饮食模式与血脂异常的相关性[J/OL]. 中华老年病研究电子杂志, 2024, 11(03): 32-37.
[13] 罗婷, 邱令智, 易东, 鄢华. 线粒体功能障碍与心血管疾病、缺血性脑卒中及慢性肾脏病关系的研究进展[J/OL]. 中华脑血管病杂志(电子版), 2024, 18(01): 60-63.
[14] 聂倩倩, 程桂荣, 曾燕, 鄢华. 代谢性心血管疾病共病增加中国社区老年人痴呆风险[J/OL]. 中华脑血管病杂志(电子版), 2024, 18(01): 27-32.
[15] 曾德阳, 董贺千禧, 陶凉, 肖红艳, 曾燕, 鄢华. 中年心血管危险因素增加阿尔茨海默病相关痴呆的流行病学和机制研究进展[J/OL]. 中华脑血管病杂志(电子版), 2024, 18(01): 6-13.
阅读次数
全文


摘要