24h平均心率对老年冠心病患者全因死亡的影响
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摘要
目的探讨24 h平均心率(AHR)对老年冠心病(CHD)患者全因死亡的影响。方法连续入选2010年6月至2012年6月在北京市海淀医院老年内科住院的老年CHD患者262例。根据出院前24 h动态心电图(holter)检查,以24 h AHR 75次/min为切点分为24 h AHR≥75次/min组71例和24 h AHR<75次/min组191例。对入选患者进行随访,2010年12月1日开始,每6个月进行一次,至2016年6月31日结束,以全因死亡为主要研究终点。收集并比较患者出院前24 h的基线资料、化验指标,以及随访期间的死亡原因。采用SPSS 19.0软件对数据进行分析。根据数据类型,组间比较采用t检验、Wilcoxon秩和检验或χ~2检验。组间累计生存率分析采用Kaplan-Meier生存曲线。采用多因素Cox比例风险模型评价随访期间CHD患者全因死亡的各种可能危险因素。结果入选患者中位随访40.7个月,患者资料完整。与24 h AHR<75次/min组比较,24 h AHR≥75次/min组患者白细胞计数、低密度脂蛋白胆固醇和尿微量白蛋白显著升高,差异有统计学意义(P<0.05)。随访期间患者总死亡率为6.87%(18/262)。与24 h AHR<75次/min组比较,24 h AHR≥75次/min组患者全因死亡率[15.49%(11/71)vs 3.66%(7/191),P=0.002]、CHD死亡率[9.86%(7/71)vs 1.57%(3/191),P=0.005]均显著升高,差异有统计学意义。Kaplan-Meier生存分析显示,24 h AHR≥75次/min组患者累计生存率显著低于24 h AHR<75次/min组(P=0.001)。多因素Cox比例风险模型分析显示,校正混杂因素后,24 h AHR≥75次/min(HR=4.604,95%CI 1.343～15.784;P=0.015)和吸烟(HR=3.943,95%CI 1.009～15.412;P=0.049)是老年CHD患者全因死亡的独立危险因素。结论 24 h AHR≥75次/min的老年CHD患者全因死亡率明显升高,通过控制24 h AHR和戒烟可能会降低老年CHD患者全因死亡率。
Objective To investigate the effect of 24-hour average heart rate(AHR) on all-cause mortality in elderly patients with coronary heart disease(CHD). Methods A total of 262 elderly CHD patients admitted in our hospital from June 2010 to June 2012 were recruited in this study. According to the results of 24-hour ambulatory electrocardiography(Holter examination) before discharge, they were divided into 24 h AHR≥75 times/min group(n=71) and 24 h AHR<75 times/min group(n=191) at the cut point of 75 times/min. The follow-up was carried out from December 1, 2010 to June 31, 2016, at an interval of 6 months, with all-cause death as the main endpoint. Their baseline data and laboratory indicators 24 h before discharge and causes of death during follow-up were collected and compared. SPSS statistics 19.0 was used to analyze the data. According to the data type, Student′s t test, Wilcoxon rank sum test and Chi-sqaure test were used for comparison between groups. Kaplan-Meier survival curve was plotted to analyze the cumulative survival rate between groups. Multivariate Cox proportional hazard model was applied to evaluate the risk factors of all-cause mortality in CHD patients during follow-up. Results The median period of follow-up was 40.7 months, and whole data of these patients were collected. Compared with the 24 h AHR<75 times/min group, the 24 h AHR≥75 times/min group had signifi-cantly higher white blood cell count, serum level of low-density lipoprotein cholesterol and urinary content of microalbumin(P<0.05). The total mortality rate during follow-up was 6.87%(18/262). The all-cause mortality rate [15.49%(11/71) vs 3.66%(7/191) P = 0. 002]and CHD mortality [9.86%( 7/71) vs 1.57%( 3/191); P = 0.005]was obviously increased in the 24 h AHR≥75 times/min group than the 24 h AHR<75 times/min group. Kaplan-Meier survival analysis showed that the cumulative survival rate of patients with 24 h AHR≥75 times/min was statistically lower than that of the patients with 24 h AHR<75 times/min( P = 0.001). Multivariate Cox proportional hazard model analysis showed that after adjustment for confounding factors,24 h AHR≥75 times/min( HR = 4. 604,95%CI 1.343-15.784; P = 0.015) and smoking( HR = 3.943,95%CI 1.009-15.412; P = 0.049) were determined as independent risk factors for all-cause death in the elderly CHD patients. Conclusion The all-cause mortality is significantly increased in the elderly CHD patients with 24 h AHR≥75 times/min. So,the mortality may be reduced by controlling 24 h AHR and quitting smoking.
Objective To investigate the effect of 24-hour average heart rate(AHR) on all-cause mortality in elderly patients with coronary heart disease(CHD). Methods A total of 262 elderly CHD patients admitted in our hospital from June 2010 to June 2012 were recruited in this study. According to the results of 24-hour ambulatory electrocardiography(Holter examination) before discharge, they were divided into 24 h AHR≥75 times/min group(n=71) and 24 h AHR<75 times/min group(n=191) at the cut point of 75 times/min. The follow-up was carried out from December 1, 2010 to June 31, 2016, at an interval of 6 months, with all-cause death as the main endpoint. Their baseline data and laboratory indicators 24 h before discharge and causes of death during follow-up were collected and compared. SPSS statistics 19.0 was used to analyze the data. According to the data type, Student′s t test, Wilcoxon rank sum test and Chi-sqaure test were used for comparison between groups. Kaplan-Meier survival curve was plotted to analyze the cumulative survival rate between groups. Multivariate Cox proportional hazard model was applied to evaluate the risk factors of all-cause mortality in CHD patients during follow-up. Results The median period of follow-up was 40.7 months, and whole data of these patients were collected. Compared with the 24 h AHR<75 times/min group, the 24 h AHR≥75 times/min group had signifi-cantly higher white blood cell count, serum level of low-density lipoprotein cholesterol and urinary content of microalbumin(P<0.05). The total mortality rate during follow-up was 6.87%(18/262). The all-cause mortality rate [15.49%(11/71) vs 3.66%(7/191) P = 0. 002]and CHD mortality [9.86%( 7/71) vs 1.57%( 3/191); P = 0.005]was obviously increased in the 24 h AHR≥75 times/min group than the 24 h AHR<75 times/min group. Kaplan-Meier survival analysis showed that the cumulative survival rate of patients with 24 h AHR≥75 times/min was statistically lower than that of the patients with 24 h AHR<75 times/min( P = 0.001). Multivariate Cox proportional hazard model analysis showed that after adjustment for confounding factors,24 h AHR≥75 times/min( HR = 4. 604,95%CI 1.343-15.784; P = 0.015) and smoking( HR = 3.943,95%CI 1.009-15.412; P = 0.049) were determined as independent risk factors for all-cause death in the elderly CHD patients. Conclusion The all-cause mortality is significantly increased in the elderly CHD patients with 24 h AHR≥75 times/min. So,the mortality may be reduced by controlling 24 h AHR and quitting smoking.
引文
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[12]Alhalabi L,Singleton MJ,Oseni AO,et al.Relation of higher resting heart rate to risk of cardiovascular versus noncardiovascular death[J].Am J Cardiol,2017,119(7):1003-1007.DOI:10.1016/j.amjcard.2016.11.059.
[13]黄元铸.心率与冠心病关系的研究进展[J].中华心血管病杂志,2006,34(6):574-576.DOI:10.3760/j:issn:0253-3758.2006.06.033.Huang YZ.Research progress on the relationship between heart rate and coronary heart disease[J].Chin J Cardiol,2006,34(6):574-576.DOI:10.3760/j:issn:0253-3758.2006.06.033.
[14]Korshj M,Lidegaard M,Kittel F,et al.The relation of ambulatory heart rate with all-cause mortality among middle-aged men:a prospective cohort study[J].PLoS One,2015,10(3):e0121729.DOI:10.1371/journal.pone.0121729.
[15]Lam TH,He Y,Li LS,et al.Mortality attributable to cigarette smoking in China[J].JAMA,1997,278(18):1505-1508.
[16]Lam TH,He Y,Shi QL,et al.Smoking,quitting,and mortality in a Chinese cohort of retired men[J].Ann Epidemiol,2002,12(5):316-320.
[2]Fihn SD,Gardin JM,Abrams J,et al.2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease:a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines,and the American College of Physicians,American Association for Thoracic Surgery,Preventive Cardiovascular Nurses Association,Society for Cardiovascular Angiography and Interventions,and Society of Thoracic Surgeons[J].Circulation,2012,126(25):354-471.DOI:10.1161/CIR.0b013e318277d6a0.
[3]Aune D,Sen A,ó'Hartaigh B,et al.Resting heart rate and the risk of cardiovascular disease,total cancer,and all-cause mortality:a systematic review and dose-response meta-analysis of prospective studies[J].Nutr Metab Cardiovasc Dis,2017,27(6):504-517.DOI:10.1016/j.numecd.2017.04.004.
[4]Ho JE,Bittner V,De Micco DA,et al.Usefulness of heart rate at rest as a predictor of mortality,hospitalzation for heart failure,myocardial infarction,and stroke in patients with stable coronay heart disease[data from the Treating to New Targets(TNT)trial][J].Am J Cardiol,2010,105:905-911.DOI:10.1016/j.amjcard.2009.11.035.
[5]Chen Y,Yang X,Nguyen Pham V,et al.Heart rate control is associated with reduced cardiovascular events in Asian patients with coronary artery disease treated with bisoprolol(BISO-CAD):results from a multi-national,real-world experience[J].Curr Med Res Opin,2018,34(2):217-225.DOI:10.1080/03007995.2017.1363729.
[6]Palatini P,Julius S.Elevated heart rate:a major risk factor for cardiovascular disease[J].Clin Exp Hypertens,2004,26(7-8):637-644.
[7]Tadic M,Cuspidi C,Grassi G.Heart rate as a predictor of cardiovascular risk[J].Eur J Clin Invest,2018,48(3):el12892.DOI:10.1111/eci.12892.
[8]B9hm M,Reil JC,Danchin N,et al.Association of heart rate with microalbuminuria in cardiovascular risk patients:data from I-SEARCH[J].J Hypertens,2008,26(1):18-25.DOI:10.1097/HJH.0b013e3282f05c8a.
[9]Waldron JS,Baoku Y,Hartland AJ,et al.Urine microalbumin excretion in relation to exercise-induced electrocardiographic myocardial ischaemia[J].Med Sci Monit,2002,8(11):725-727.
[10]Muntner P,Bowling CB,Gao L,et al.Age-specific association of reduced estimated glomerular filtration rate and albuminuria with all-cause mortality[J].Clin J Am Soc Nephrol,2011,6(9):2200-2207.DOI:10.2215/CJN.02030311.
[11]Reil JC,Custodis F,Swedberg K,et al.Heart rate reduction in cardiovascular disease and therapy[J].Clin Res Cardiol,2011,100(1):11-19.DOI:10.1007/s00392-010-0207-x.
[12]Alhalabi L,Singleton MJ,Oseni AO,et al.Relation of higher resting heart rate to risk of cardiovascular versus noncardiovascular death[J].Am J Cardiol,2017,119(7):1003-1007.DOI:10.1016/j.amjcard.2016.11.059.
[13]黄元铸.心率与冠心病关系的研究进展[J].中华心血管病杂志,2006,34(6):574-576.DOI:10.3760/j:issn:0253-3758.2006.06.033.Huang YZ.Research progress on the relationship between heart rate and coronary heart disease[J].Chin J Cardiol,2006,34(6):574-576.DOI:10.3760/j:issn:0253-3758.2006.06.033.
[14]Korshj M,Lidegaard M,Kittel F,et al.The relation of ambulatory heart rate with all-cause mortality among middle-aged men:a prospective cohort study[J].PLoS One,2015,10(3):e0121729.DOI:10.1371/journal.pone.0121729.
[15]Lam TH,He Y,Li LS,et al.Mortality attributable to cigarette smoking in China[J].JAMA,1997,278(18):1505-1508.
[16]Lam TH,He Y,Shi QL,et al.Smoking,quitting,and mortality in a Chinese cohort of retired men[J].Ann Epidemiol,2002,12(5):316-320.