Resting heart rate and incident heart failure and cardiovascular mortality in older adults: role of inflammation and endothelial dysfunction: the PROSPER study
Resting heart rate and incident heart failure and cardiovascular mortality in older adults: role of inflammation and endothelial dysfunction: the PROSPER study
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DOI：
10.1093/eurjhf/hfs195
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发表时间：
2013-05-01
影响因子：
18.2
通讯作者：
de Craen, Anton J. M.
中科院分区：
文献类型：
--
作者：
Nanchen, David;Stott, David J.;de Craen, Anton J. M.
静息心率是老年人中一个有希望的可改变的心血管风险标志物，但心率与心血管疾病之间的联系机制尚未完全了解。我们的目的是评估静息心率和事件心力衰竭（HF）和心血管死亡率之间的关联，并检查这些关联是否可能归因于全身炎症和内皮功能障碍。我们研究了4084名年龄在70 - 82岁的老年人，他们有已知的心血管危险因素或既往心血管疾病，在PROSPER研究中没有预先存在的HF或β受体阻滞剂。在3.2年的随访期内，我们根据静息心率、沿着C-反应蛋白（CRP）、白细胞介素-6（IL-6）、组织纤溶酶原激活物（tPA）和血管性血友病因子（vWf）检查了HF住院事件和心血管死亡率。男性的平均心率为67次/分，女性为70次/分。CRP、IL-6、tPA和vWf水平均与心率呈正相关。多变量校正后，心率与HF住院治疗[最高与最低分布第三位的风险比（HR）1.78，95置信区间（CI）1.212.63，P 0.003]和心血管死亡率（HR 1.74，95 CI 1.232.47，P 0.002）相关。进一步调整IL-6和vWf水平使HF的HR降至1.60（95 CI 1.082.38，P 0.020），心血管死亡率降至1.50（95 CI 1.042.15，P 0.028）。这些因素可能导致但不能完全解释与老年心率增加相关的HF和心血管死亡风险。
Resting heart rate is a promising modifiable cardiovascular risk marker in older adults, but the mechanisms linking heart rate to cardiovascular disease are not fully understood. We aimed to assess the association between resting heart rate and incident heart failure (HF) and cardiovascular mortality, and to examine whether these associations might be attributable to systemic inflammation and endothelial dysfunction.We studied 4084 older adults aged 7082 years with known cardiovascular risk factors or previous cardiovascular disease, without pre-existing HF or beta-blockers in the PROSPER study. Over a 3.2-year follow-up period, we examined incident HF hospitalization and cardiovascular mortality according to resting heart rate, along with C-reactive protein (CRP), interleukin-6 (IL-6), tissue plasminogen activator (tPA), and von Willebrand factor (vWf). Mean heart rate was 67 b.p.m. for men and 70 b.p.m. for women. CRP, IL-6, tPA, and vWf levels were all positively correlated with heart rate. After multivariate adjustment, heart rate was associated with HF hospitalization [hazard ratio (HR) 1.78 for highest vs. lowest distribution third, 95 confidence interval (CI) 1.212.63, P 0.003] and cardiovascular mortality (HR 1.74, 95 CI 1.232.47, P 0.002). Further adjustment for both IL-6 and vWf levels decreased HR to 1.60 (95 CI 1.082.38, P 0.020) for HF and to 1.50 (95 CI 1.042.15, P 0.028) for cardiovascular mortality.Increased heart rate is associated with increased systemic inflammation and endothelial dysfunction. These factors are likely to contribute to, but do not fully explain, the risk of HF and cardiovascular death associated with increased heart rate in older age.