Cardiac autonomic function and incident coronary heart disease: A population-based case-cohort study - The ARIC study
Cardiac autonomic function and incident coronary heart disease: A population-based case-cohort study - The ARIC study
复制标题
DOI：
10.1093/aje/145.8.696
复制
发表时间：
1997-04-15
影响因子：
5
通讯作者：
Heiss, G
中科院分区：
文献类型：
--
作者：
Liao, DP;Cai, JW;Heiss, G
通过心率变异性评估的心脏自主活动被发现与心肌梗塞后死亡率、猝死和全因死亡率相关。然而，心率变异性与冠心病（CHD）发病率之间的关系尚未得到很好的描述。作者采用病例队列设计对从美国四个研究中心选出的社区动脉粥样硬化风险研究队列进行了 3 年（1990-1992 年）随访，报告了基线心脏自主活动（1987-1989 年）与 CHD 事件之间的关联。作者检查了 137 例 CHD 事件病例和 2,252 名基线时未患 CHD 受试者的分层随机样本。收集基线、仰卧位、静息逐次心跳心率数据。通过频谱分析估计的高（0.16-0.35 Hz）和低（0.025-0.15 Hz）频谱功率和当前高频率功率比，以及通过时域分析计算的所有正常R-R间隔的标准差，分别用作心脏副交感神经、交感-副交感神经及其平衡的常规指标。事件 CHD 被定义为住院心肌梗塞、致命性 CHD 或 3 年随访期间的心脏血运重建手术。比较高频功率、低频功率、高/低频功率比和 R-R 间隔标准差的最低四分位数与最高四分位数，年龄、种族、性别和其他 CHD 危险因素调整后的 CHD 事件相对风险（和 95% 置信区间）分别为 1.72（95% 置信区间 (Cl) 1.17-2.51）、1.09（95% Cl）分别为 0.72-1.64)、1.25 (95% Cl 0.84-1.86) 和 1.39 (95% Cl 0.94-2.04)。这项基于人群的前瞻性研究结果表明，心脏自主活动的改变，尤其是副交感神经活动的降低，与患冠心病的风险相关。
Cardiac autonomic activity, as assessed by heart rate variability, has been found to be associated with postmyocardial infarction mortality, sudden death, and all-cause mortality. However, the association of heart rate variability and the incidence of coronary heart disease (CHD) is not well described. The authors report on the association of baseline cardiac autonomic activity (1987-1989) with incident CHD after 3 years (1990-1992) of follow-up of the Atherosclerosis Risk in Communities Study cohort selected from four study centers in the United States by using a case-cohort design, The authors examined 137 incident cases of CHD and a stratified random sample of 2,252 examinees free of CHD at baseline. Baseline, supine, resting beat-to-beat heart rate data were collected. High-(0.16-0.35 Hz) and low-(0.025-0.15 Hz) frequency spectral powers and high-now-frequency power ratio, estimated from spectral analysis, and standard deviation of all normal R-R intervals, calculated from time domain analysis, were used as the conventional indices of cardiac parasympathetic, sympatho-parasympathetic, and their balance, respectively. Incident CHD was defined as hospitalized myocardial infarction, fatal CHD, or cardiac revascularization procedures during 3 years of follow-up. The age, race, gender, and other CHD risk factor-adjusted relative risks (and 95% confidence intervals) of incident CHD comparing the lowest quartile with the upper three quartiles of high-frequency power, low-frequency power, high-/low-frequency power ratio, and standard deviation of R-R intervals were 1.72 (95% confidence interval (Cl) 1.17-2.51), 1.09 (95% Cl 0.72-1.64), 1.25 (95% Cl 0.84-1.86), and 1.39 (95% Cl 0.94-2.04), respectively. The findings from this population-based, prospective study suggest that altered cardiac autonomic activity, especially lower parasympathetic activity, is associated with the risk of developing CHD.