心率快的男性心力衰竭风险高

罗马——一项包含1,800多名荷兰男性的以人群为基础的队列研究显示，与心率较慢的男性相比，心率≥79次/分的健康、年龄较大男性发生心力衰竭的风险大约增加50%。

David Nanchen医生

瑞士洛桑大学心血管预防医院负责人David Nanchen医生进行的这项研究中包含参与鹿特丹研究的生活于鹿特丹地区的表观健康的年龄≥55岁的4,768例受试者。在中位随访15年期间，656例参与者发生心力衰竭。分析中排除了基线时有心力衰竭、冠心病、心房纤颤、房室传导阻滞或佩戴起搏器、以及接受受体阻滞剂或钙通道阻滞剂治疗的患者。

结果显示，在1,829名男性受试者中，基线时静息心率每增加10次/分，则心力衰竭发生率相对增加16%，并具有统计学意义，而在女性中未见这种关联。当研究者按照基线时的心率将男性受试者分为三部分时，发现处于最高三分位数(心率≥79次/分)的男性随访期间的心力衰竭发生率较处于最低三分位数(心率＜69次/分)的男性增加51%，具有统计学意义。这一分析中校正了年龄、吸烟状态、收缩压、糖尿病、体重指数、总胆固醇水平、HDL胆固醇水平和抗高血压治疗等因素的影响。

这项研究中还包括一项针对中位随访15年期间发生心肌梗死(MI)男性的分析，可以排除继发于MI的心力衰竭病例。排除MI作为较高心率与心力衰竭发生之间的介导因素，意味着可能有其他病理过程的参与。一个可能就是心率较高患者发生心动过速诱导的心肌病，并进展至心力衰竭。但随访期间静息心率增快与心力衰竭风险之间的明显关联仅见于男性。该分析中另外包含2,939例女性，结果未提示基线心率与之后发生心力衰竭之间存在任何关联。

研究者总结认为，在年龄≥55岁的男性中，心率较快与心力衰竭风险增高相关，并且心率对于心力衰竭风险的影响独立于其他危险因素。调整生活方式和其他减慢心率的治疗可能有助于降低心力衰竭风险。

Nanchen医生披露无相关利益冲突。

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By: MITCHEL L. ZOLER, Cardiology News Digital Network

ROME – Otherwise healthy, older men with a heart rate of 79 beats per minute or higher had a roughly 50% increased risk of developing heart failure, compared with men with slower heart rates, in a population-based cohort of more than 1,800 Dutch men.

The finding suggests that heart rate, independent of any other cardiovascular risk factor, could boost the risk for developing heart failure, and raises the possibility of trying to dampen this effect by using interventions to reduce heart rate, Dr. David Nanchen said at the annual meeting of the European Society of Cardiology.
 
But the apparent link between resting heart rate and a boosted incidence of heart failure during follow-up occurred only in men. The analysis also included 2,939 women, who showed no suggestion of an association between baseline heart rate and subsequent development of heart failure.

The work reported by Dr. Nanchen also included an analysis that censored men who had an incident myocardial infarction during a median follow-up of 15 years, thereby eliminating cases of heart failure that occurred following an MI. In this analysis, men with a baseline heart rate of 79 beats per minute or greater had a statistically significant, 56% increased incidence of heart failure compared with men with an entry heart rate of less than 69 beats per minute, said Dr. Nanchen, head of the cardiovascular preventative clinic of the University of Lausanne (Switzerland).

Ruling out MI as a mediator between high heart rate and the development of heart failure means some other pathologic sequence is involved. One possibility is that patients with high heart rates develop tachycardia-induced cardiomyopathy that progresses to heart failure, Dr. Nanchen said in an interview."

His study included 4,768 people aged 55 or older enrolled in the Rotterdam Study from among apparently healthy people living in the Rotterdam area. During a median follow-up of 15 years, 656 enrollees developed heart failure. The analysis excluded people who at baseline had heart failure, coronary heart disease, atrial fibrillation, atrioventricular block, or a pacemaker, or were taking a beta-blocker or calcium channel blocker.

Among the 1,829 men in the study, every increment of 10 beats per minute in resting heart rate at entry into the study was linked with a statistically significant, 16% relative increase in the incidence of heart failure, an association not seen in women. When the researchers divided the men into tertiles based on their baseline heart rate, those in the top tertile with a rate of 79 beats per minute or greater had a 51% increased incidence of heart failure during follow-up, compared with men in the lowest tertile, with a rate of less than 69 beats per minute.

The analysis adjusted for age, smoking status, systolic blood pressure, diabetes, body mass index, total cholesterol level, HDL cholesterol level, and antihypertensive treatment.

The absence of this heart rate and heart failure link in women was a "surprise," Dr. Nanchen said. It’s possible that women’s hearts are more resilient to high heart rates, he suggested.

For the time being, the only intervention to offer otherwise healthy men older than 55 with a high heart rate is intensified control of lifestyle risk factors. Trial results showed that treatment with the heart rate–lowering drug ivabradine (Prooralan) in heart failure patients led to a reduction in heart failure–related hospitalizations (Lancet 2010;376:875-85).That experience makes it attractive to speculate that ivabradine treatment might also improve outcomes in men with high heart rates and no heart failure, but Dr. Nanchen said he had no immediate plans to test that hypothesis.

U.S. physicians won’t get the chance to study ivabradine in clinical practice for some time. Its manufacturer, Servier, has not disclosed any plans to submit a new drug application to the Food and Drug Administration.

Dr. Nanchen said he had no relevant financial disclosures.