Association of Asymptomatic Bradycardia With Incident Cardiovascular Disease and Mortality The Multi-Ethnic Study of Atherosclerosis (MESA)
Association of Asymptomatic Bradycardia With Incident Cardiovascular Disease and Mortality The Multi-Ethnic Study of Atherosclerosis (MESA)
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DOI：
10.1001/jamainternmed.2015.7655
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发表时间：
2016-02-01
影响因子：
39
通讯作者：
Bertoni, Alain G.
中科院分区：
文献类型：
--
作者：
Dharod, Ajay;Soliman, Elsayed Z.;Bertoni, Alain G.
重要性 在特定人群中，心动过缓与较低的心血管疾病 (CVD) 风险相关。关于中年或老年人心率 (HR) 低于 50 次/分钟 (bpm) 的可用信息很少。 目的 确定无症状心动过缓是否与较低的心血管风险状况、较少的亚临床动脉粥样硬化以及减少的 CVD 和死亡率相关。 设计、环境和参与者 这项回顾性分析包括 6733 名参加多种族研究的参与者动脉粥样硬化，从 2000 年到 2002 年招募了年龄在 45 岁到 84 岁之间、没有临床心血管疾病的男性和女性，并对他们的 CVD 事件和死亡率进行了 10 多年的跟踪。通过基线心电图测量 HR。该分析于 2014 年 6 月进行。 主要结果和措施 使用针对潜在混杂因素和中介因素进行调整的 Cox 比例风险模型来检查 HR 类别与 CVD 事件和全因死亡率之间的关联。 结果 6733 名参与者的平均 (SD) 年龄为 62 (10.2) 岁； 47%是男性。在 5831 名未服用心率调节药物的参与者中，平均 (SD) HR 为 63 (9.5) bpm； 5.3% 的心率低于 50 bpm。初步结果显示，根据 HR 修饰药物的使用情况，HR 类别之间存在显着的交互作用（P = .002）；因此，所有进一步的分析都是分层的。在任一亚组（服用或不服用心率调节药物的参与者）中，心率低于 50 bpm 均与 CVD 事件无关。在未服用 HR 调节药物的参与者中，HR 低于 50 bpm 的完全调整死亡风险没有差异（风险比，0.71 [95% CI，0.41-1.09]；P = .12），而 HR 大于 80 bpm 的参与者则增加（风险比，1.49 [95% CI，1.08-2.05]；P = .01）（参考 HR， 60-69 bpm）。在服用 HR 修饰药物的 902 名参与者中，HR 低于 50 bpm（风险比，2.42 [95% CI，1.39-4.20]；P = 0.002）和 HR 大于 80 bpm（风险比，3.55 [95% CI，1.65-7.65]；P = 0.001）相关的死亡风险升高（参考 HR， 60-69 bpm）。 结论和相关性 在当代社区队列中，心动过缓通常与 CVD 事件或死亡率无关，但服用心率调节药物的患者心动过缓之间存在潜在的不利关联。
IMPORTANCE Bradycardia has been associated with lower cardiovascular disease (CVD) risk in selected populations. There is a paucity of information available about heart rate (HR) less than 50 beats per minute (bpm) among middle-aged or older adults.OBJECTIVE To determine whether asymptomatic bradycardia was associated with a lower cardiovascular risk profile, less subclinical atherosclerosis, and decreased incident CVD and mortality.DESIGN, SETTING, AND PARTICIPANTS This retrospective analysis includes 6733 participants of the Multi-Ethnic Study of Atherosclerosis, which recruited men and women free of clinical cardiovascular disease ages 45 to 84 years from 2000 to 2002 and followed them over 10 years for incident CVD events and mortality. The HR was measured by baseline electrocardiogram. The analysis was performed in June 2014.MAIN OUTCOMES AND MEASURES The association between HR categories with CVD events and all-cause mortality were examined using Cox proportional hazards models adjusted for potential confounders and mediators.RESULTS The 6733 participants had a mean (SD) age of 62 (10.2) years; 47% were male. The mean (SD) HR was 63 (9.5) bpm among the 5831 participants not taking an HR-modifying drug; 5.3% had an HR lower than 50 bpm. Preliminary results revealed significant interaction for HR categories according to use of HR-modifying drugs for mortality (P = .002); thus, all further analyses were stratified. An HR of less than 50 bpm was not associated with incident CVD in either subgroup (participants taking or not taking HR-modifying drugs). Among participants not taking HR-modifying drugs, the fully adjusted mortality risk was not different for an HR less than 50 bpm (hazard ratio, 0.71 [95% CI, 0.41-1.09]; P = .12) and increased among those with an HR greater than 80 bpm (hazard ratio, 1.49 [95% CI, 1.08-2.05]; P = .01) (reference HR, 60-69 bpm). Among the 902 participants taking HR-modifying drugs there was an elevated mortality risk associated with an HR less than 50 bpm (hazard ratio, 2.42 [95% CI, 1.39-4.20]; P = .002) and with an HR greater than 80 bpm (hazard ratio, 3.55 [95% CI, 1.65-7.65]; P = .001) (reference HR, 60-69 bpm).CONCLUSIONS AND RELEVANCE In a contemporary, community-based cohort, bradycardia was generally not associated with incident CVD or mortality except for a potential adverse association between bradycardia among those taking HR-modifying drugs.