夷陵地区中老年人群静息心率升高与脂代谢异常的相关性研究
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摘要
目的:研究夷陵地区中老年人群静息心率升高与脂代谢异常的相关性。方法 :选取湖北省宜昌市夷陵地区9 994名40岁以上常住居民进行问卷调查、体格检查(包括血压、静息心率等)、生化检测(包括血糖、血脂等)。脂代谢异常诊断采用中国成人血脂异常防治指南(2016年修订版)诊断标准。按静息心率水平将人群分为4组,分别为<70、70～79、80～89及≥90次/min。采用Logistic回归分析静息心率升高与脂代谢异常的相关性。结果:随着静息心率增高,男性高三酰甘油(triglyceride,TG)血症、高胆固醇血症、高低密度脂蛋白胆固醇(low-density lipoprotein-cholesterol,LDL-C)血症及低高密度脂蛋白胆固醇(high-density lipoprotein-cholesterol,HDL-C)血症的患病率显著升高(趋势P<0.05),而女性中,仅高TG血症患病率呈现增加趋势(趋势P<0.05)。多元Logistic回归分析显示,校正传统危险因素后,心率≥90次/min的男性其高TG血症、高胆固醇血症、高LDL-C血症及低HDL-C血症的患病风险明显高于心率<70次/min的男性[优势比(odds ratio, OR)、95%可信区间(confidence interval, CI)分别为1.85(1.26～2.71)、1.43(1.03～1.98)、1.60(1.04～2.47)、2.17(1.08～4.36)]。心率≥90次/min的女性高TG血症的患病风险高于心率<70次/min的女性[OR(95%CI):1.71(1.25～2.34)]。结论:夷陵地区中老年人群静息心率升高与脂代谢异常的患病风险呈正相关。
Objective To investigate the association between elevated resting heart rate and dyslipidemia in middle-aged and elderly people in Yiling district. Methods A total of 9 994 individuals aged 40 years or older in Yiling district,Yichang city, Hubei province, were enrolled. Clinical data were acquired by questionnaire interview, physical examination and laboratory analysis. The participants were divided into four groups according to the heart rates(<70, 70-79, 80-89,and ≥90 beats/min). Dyslipidemia was defined according to the Chinese Guidelines on Prevention and Treatment of Dys-lipidemia in Adults(2016 revised edition). Multiple Logistic regression analysis was performed to probe the association of elevated resting heart rate and dyslipidemia. Results The prevalence of high triglyceride(TG), high total cholesterol(TC),high low-density lipoprotein-cholesterol(LDL-C) and low high-density lipoprotein-cholesterol(HDL-C) increased in male along with elevation of the resting heart rate(Ptrend<0.05), while only the morbidity of high TG was increased in females with higher resting heart rate(Ptrend<0.05). Multiple Logistic regression revealed increased risks of 1.85-fold [95%confidence interval(CI): 1.26-2.71] for high TG, a 1.43-fold(95%CI: 1.03-1.98) for high TC, a 1.60-fold(95%CI: 1.04-2.47) for high LDL-C and a 2.17-fold(95%CI: 1.08-4.36) for low HDL-C in males with heart rate ≥90 beats/min than with heart rate <70 beats/min. The increment of heart rate from blow 70 to over 90 beats/min increased the risk for high TG for 1.71-fold(95%CI: 1.25-2.34). Conclusions Elevated resting heart rate is significantly associated with dyslipidemia in middle-aged and elderly people in Yiling district.
Objective To investigate the association between elevated resting heart rate and dyslipidemia in middle-aged and elderly people in Yiling district. Methods A total of 9 994 individuals aged 40 years or older in Yiling district,Yichang city, Hubei province, were enrolled. Clinical data were acquired by questionnaire interview, physical examination and laboratory analysis. The participants were divided into four groups according to the heart rates(<70, 70-79, 80-89,and ≥90 beats/min). Dyslipidemia was defined according to the Chinese Guidelines on Prevention and Treatment of Dys-lipidemia in Adults(2016 revised edition). Multiple Logistic regression analysis was performed to probe the association of elevated resting heart rate and dyslipidemia. Results The prevalence of high triglyceride(TG), high total cholesterol(TC),high low-density lipoprotein-cholesterol(LDL-C) and low high-density lipoprotein-cholesterol(HDL-C) increased in male along with elevation of the resting heart rate(Ptrend<0.05), while only the morbidity of high TG was increased in females with higher resting heart rate(Ptrend<0.05). Multiple Logistic regression revealed increased risks of 1.85-fold [95%confidence interval(CI): 1.26-2.71] for high TG, a 1.43-fold(95%CI: 1.03-1.98) for high TC, a 1.60-fold(95%CI: 1.04-2.47) for high LDL-C and a 2.17-fold(95%CI: 1.08-4.36) for low HDL-C in males with heart rate ≥90 beats/min than with heart rate <70 beats/min. The increment of heart rate from blow 70 to over 90 beats/min increased the risk for high TG for 1.71-fold(95%CI: 1.25-2.34). Conclusions Elevated resting heart rate is significantly associated with dyslipidemia in middle-aged and elderly people in Yiling district.
引文
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[2]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.
[3]Seviiri M,Lynch BM,Hodge AM,et al.Resting heart rate,temporal changes in resting heart rate,and overall and cause-specific mortality[J].Heart,2018,104(13):1076-1085.
[4]Lindgren M,Robertson J,Adiels M,et al.Resting heart rate in late adolescence and long term risk of cardiovascular disease in Swedish men[J].Int J Cardiol,2018,259:109-115.
[5]Wu X,Du R,Hu C,et al.Resting heart rate is associated with metabolic syndrome and predicted 10-year risk of cardiovascular disease:a cross-sectional study[J].J Diabetes,2019.[Epub ahead of print].
[6]Bhm M,Schumacher H,Teo KK,et al.Resting heart rate and cardiovascular outcomes in diabetic and non-diabetic individuals at high cardiovascular risk analysis from the ONTARGET/TRANSCEND trials[J].Eur Heart J,2018.[Epub ahead of print].
[7]Chen S,Li W,Jin C,et al.Resting heart rate trajectory pattern predicts arterial stiffness in a community-based Chinese cohort[J].Arterioscler Thromb Vasc Biol,2017,37(2):359-364.
[8]Wang L,Cui L,Wang Y,et al.Resting heart rate and the risk of developing impaired fasting glucose and diabetes:the Kailuan prospective study[J].Int J Epidemiol,2015,44(2):689-699.
[9]Kim DI,Yang HI,Park JH,et al.The association between resting heart rate and type 2 diabetes and hypertension in Korean adults[J].Heart,2016,102(21):1757-1762.
[10]Wang A,Liu X,Guo X,et al.Resting heart rate and risk of hypertension:results of the Kailuan cohort study[J].JHypertens,2014,32(8):1600-1605.
[11]Latvala A,Kuja-Halkola R,Rück C,et al.Association of resting heart rate and blood pressure in late adolescence with subsequent mental disorders[J].JAMA Psychiatry,2016:73(12):1268-1275.
[12]Charland SL,Cziraky MJ,Quimbo R,et al.Achieving optimal lipid values in patients with dyslipidemia is associated with reduced risk of cardiovascular events[J].J Clin Lipidol,2008,2(5):343-353.
[13]Knowles JW,Howard WB,Karayan L,et al.Access to nonstatin lipid-lowering therapies in patients at high risk of atherosclerotic cardiovascular disease[J].Circulation,2017,135(22):2204-2206.
[14]Shigetoh Y,Adachi H,Yamagishi S,et al.Higher heart rate may predispose to obesity and diabetes mellitus:20-year prospective study in a general population[J].Am JHypertens,2009,22(2):151-155.
[15]Bnaa KH,Arnesen E.Association between heart rate and atherogenic blood lipid fractions in a population[J].Circulation,1992,86(2):394-405.
[16]中国成人血脂异常防治指南修订联合委员会.中国成人血脂异常防治指南(2016年修订版)[J].中华心血管病杂志,2016,44(10):833-853.
[17]Palatini P,Julius S.Heart rate and the cardiovascular risk[J].J Hypertens,1997,15(1):3-17.
[18]Palatini P,Benetos A,Grassi G,et al.Identification and management of the hypertensive patient with elevated heart rate:statement of a European Society of Hypertension Consensus Meeting[J].J Hypertens,2006,24(4):603-610.
[19]Mancia G,De BG,Dominiczak A,et al.2007 Guidelines for the management of arterial hypertension:the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension(ESH)and of the European Society of Cardiology(ESC)[J].Blood Press,2007,16(3):135-232.
[20]Robinson BF,Epstein SE,Beiser GD,et al.Control of heart rate by the autonomic nervous system.Studies in man on the interrelation between baroreceptor mechanisms and exercise[J].Circ Res,1966,19(2):400-411.
[21]Cleophas TJ,van Marum R.Age-related decline in autonomic control of blood pressure:implications for the pharmacological management of hypertension in the elderly[J].Drugs Aging,2003,20)5):313-319.
[22]Yang Z,Xu B,Lu J,et al.Autonomic test by EZSCAN in the screening for prediabetes and diabetes[J].PLoS One,2013,8(2):e56480.
[23]Sun K,Liu Y,Dai M,et al.Accessing autonomic function can early screen metabolic syndrome[J].PLoS One,2012,7(8):e43449.
[24]Sun JC,Huang XL,Deng XR,et al.Elevated resting heart rate is associated with dyslipidemia in middle-aged and elderly Chinese[J].Biomed Environ Sci,2014,27(8):601-605.
[25]Morselli E,Frank AP,Santos RS,et al.Sex and gender:critical variables in pre-clinical and clinical medical research[J].Cell Metab,2016,24(2):203-209.
[26]Barrett-Connor E,Khaw KT.Endogenous sex hormones and cardiovascular disease in men.A prospective population-based study[J].Circulation,1988,78(3):539-545.
[27]Yang HI,Kim HC,Jeon JY.The association of resting heart rate with diabetes,hypertension,and metabolic syndrome in the Korean adult population:the fifth Korea National Health and Nutrition Examination Survey[J].Clin Chim Acta,2016,455:195-200.
[28]Ahmed HM,Al-Mallah MH,Keteyian SJ,et al.Sex-specific maximum predicted heart rate and its prognosis for mortality and myocardial infarction[J].Med Sci Sports Exerc,2017,49(8):1704-1710.
[29]Palatini P.Heart rate as predictor of outcome[J].Blood Press Monit,2008,13(3):167-168.
[30]Palatini P,Thijs L,Staessen JA,et al.Predictive value of clinic and ambulatory heart rate for mortality in elderly subjects with systolic hypertension[J].Arch Intern Med,2002,162(20):2313-2321.