Objective: To prospectively explore the relationship between resting heart rate (RHR) and risk of new-onset heart failure. Methods: It was a prospective cohort study. People who attended the physical examination of Kailuan Group Company in 2006 and with complete electrocardiography (ECG) recordings were eligible for this study. A total of 88 879 participants aged 18 years old or more who were free of arrhythmia, a prior history of heart failure and were not treated with β-blocker were included. Participants were divided into 5 groups according to the quintiles of RHR at baseline (Q(1) group, 40-60 beats/minutes (n=18 168) ; Q(2) group, 67-70 beats/minutes (n=18 970) ; Q(3) group, 71-74 beats/minutes (n=13 583) ; Q(4) group, 75-80 beats/minutes (n=22 739) ; and Q(5) group,>80 beats/minutes (n=15 419) ) .The general clinical data and laboratory test results were collected. The outcome was the first occurrence of heart failure at the end of follow-up (December 31, 2016) .We used Cox regression model to examine the association between RHR and the risk of new-onset heart failure. Hazard ratio (HR) with 95% confidence intervals (CI) were calculated using Cox regression modeling. Results: Among the included patients 68 411 participants were male, mean age was (51.0±12.3) years old, and RHR was (74±10) beats/minutes. Statistically significant differences among the RHR quintiles were found for the following variables: age, gender, systolic blood pressure, diastolic blood pressure, triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, fasting blood glucose, body mass index, the level of high-sensitivity C-reactive protein, education status, physical activity, smoking status, drinking status, history of diabetes, history of hypertension and history of use antihypertensive drugs (all P<0.01) . Higher RHR was linked with higher prevalence of diabetes, hypertension history, and higher systolic blood pressure, diastolic blood pressure and FBG levels (all P<0.01). After a mean follow-up of 9.5 years, the incidence of new-onset heart failure in Q(1), Q(2), Q(3), Q(4) and Q(5) groups was 1.60%(290/18 168), 1.36%(258/18 970), 1.80%(245/13 583), 1.76%(400/22 739) and 2.35%(362/15 419),respectively (P<0.01) . The person-year incidence of heart failure in Q(1), Q(2), Q(3), Q(4) and Q(5) groups was 1.7, 1.5, 1.9, 1.9 and 2.6 per 1 000 person-years respectively. Compared with the Q(2) group, multivariate analysis with adjustment for major traditional cardiovascular risk factors showed that HRs of Q(3),Q(4),and Q(5) group were 1.23 (95%CI 1.03-1.48, P<0.05) , 1.19 (95%CI 1.01-1.41, P<0.05) , 1.39 (95%CI 1.18-1.65, P<0.01) , respectively. In the absence of hypertension, diabetes, smoking and acute myocardial infarction, the Cox regression model showed that compared with Q(2) group, the HR of new-onset heart failure in Q(5) group was 1.58 (95%CI 1.02-2.45, P<0.05) . Conclusion: Increased RHR is associated with increased risk of new-onset heart failure in this cohort.
目的： 探讨静息心率加快对人群新发心力衰竭（心衰）的影响。 方法： 该研究为前瞻性队列研究。选取参加了2006年度开滦集团公司职工健康体检且体检时完成心电图检查、静息心率数据完整者作为研究对象，排除患有心律失常者、服用β受体阻滞剂者以及有心衰病史者。根据静息心率将入选者进行五分位分组，即Q(1)、Q(2)、Q(3)、Q(4)、Q(5)组。收集入选者的一般临床资料及实验室检查结果。以新发心衰为终点事件。研究随访至2016年12月31日。采用多因素Cox回归模型分析不同静息心率组人群发生新发心衰的风险。 结果： 研究最终入选88 879人，年龄18~98（51.0±12.3）岁，其中男性68 411人，静息心率（74±10）次/min。静息心率40~66次/min的人群归入Q(1)组（n=18 168），静息心率67~70次/min的人群归入Q(2)组（n=18 970），静息心率71~74次/min的人群归入Q(3)组（n=13 583），静息心率75~80次/min的人群归入Q(4)组（n=22 739），静息心率>80次/min的人群归入Q(5)组（n=15 419）。5组人群年龄、性别、收缩压、舒张压、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、空腹血糖（FBG）、体重指数（BMI）、高敏C反应蛋白（hs-CRP）、教育程度、体育锻炼情况、吸烟情况、饮酒情况、糖尿病病史、高血压病史、服用降压药物情况差异均有统计学差异（P均<0.01），并且随着心率加快，有糖尿病病史、高血压病史者比例以及收缩压、舒张压、FBG水平依次升高（P均<0.01）。平均随访9.5年，Q(1)、Q(2)、Q(3)、Q(4)、Q(5)组人群新发心衰发病率分别为1.60%（290/18 168）、1.36%（258/18 970）、1.80%（245/13 583）、1.76%（400/22 739）、2.35%（362/15 419），组间差异有统计学意义（P<0.01）；人年发病率依次为1.7/千人年、1.5/千人年、1.9/千人年、1.9/千人年、2.6/千人年。校正了主要传统心血管危险因素后多因素Cox回归分析结果显示，与Q(2)组相比，Q(3)、Q(4)组、Q(5)组人群新发心衰的HR分别为1.23（95%CI 1.03~1.48，P<0.05）、1.19（95%CI 1.01~1.41，P<0.05）、1.39（95%CI 1.18~1.65，P<0.01）。除外了高血压患者、糖尿病患者、吸烟者以及随访期间发生急性心肌梗死者后重复多因素Cox回归分析，结果显示与Q(2)组相比，Q(5)组人群新发心衰的HR为1.58（95%CI 1.02~2.45，P<0.05）。 结论： 静息心率加快增加人群新发心衰风险。.
Keywords: Heart failure; Resting heart rate.