Summary
Background
Higher resting heart rate, a simple and useful indicator of autonomic balance and metabolic rate, has emerged as an independent predictor for atherosclerotic cardiovascular disease.
Aim
To determine the association between resting heart rate and arterial stiffness measured by brachial-ankle pulse wave velocity (baPWV).
Methods
We examined the association between resting heart rate and baPWV in 641 Korean adults (366 men, 275 women) in a health examination program. A high baPWV was defined as greater than 1450 cm/s (> 75th percentile). The odds ratios for high baPWVs were calculated using multivariable logistic regression analysis after adjusting for confounding variables across heart rate quartiles (Q1 ≤ 56, Q2 = 57–62, Q3 = 63–68, Q4 ≥ 69 beats/min).
Results
Age-adjusted baPWV mean values increased gradually with heart rate quartile (Q1 = 1281, Q2 = 1285, Q3 = 1354, Q4 = 1416 cm/s). The odds ratios (95% confidence intervals) for high baPWVs in each heart rate quartile were 1.00, 1.28 (0.57–2.86), 2.63 (1.20–5.79) and 3.66 (1.66–8.05), respectively, after adjusting for age, sex, smoking status, alcohol intake, exercise, body mass index, hypertension medication, diabetes medication, hyperlipidaemia medication, mean arterial blood pressure, fasting plasma glucose, total cholesterol, triglycerides, high-density lipoprotein cholesterol, white blood cell count, aspartate aminotransferase, alanine aminotransferase, γ-glutamyltransferase and uric acid.
Conclusion
These findings indicate that a higher resting heart rate is independently associated with arterial stiffness. Accordingly, early detection of increased resting heart rate is important for preservation of arterial function and assessment of cardiovascular risk.
Résumé
Le contexte
Un rythme cardiaque plus élevé au repos, un indicateur simple et utile de l’équilibre autonome et du métabolisme, est apparu comme un indicateur de maladie cardiovasculaire athérosclérotique.
Objectif
Déterminer l’association du rythme cardiaque élevé au repos avec la rigidité artérielle par la vitesse de l’onde de pouls cheville/bras ( brachial-ankle pulse wave velocity [baPWV]).
Méthode
Nous examinons l’association entre le rythme cardiaque élevé au repos et le baPWV sur 641 adultes coréens (366 hommes, 275 femmes) dans le cadre du programme de l’examen. Un baPWV élevé est défini lorsque que celui-ci dépasse plus de 1450 cm/s (> 75 e percentile). L’ odds ratio (ou rapport de chances) pour le baPWV élevé a été calculé en utilisant l’analyse de la régression logistique multivariée, après rectification des variables de perturbation à travers les quartiles du rythme cardiaque élevé au repos (Q1 ≤ 56, Q2 = 57–62, Q3 = 63–68 et Q4 ≥ 69 battements par minute).
Résultats
Le baPWV à l’âge ajusté signifie que les valeurs ont progressivement augmenté avec le quartile du rythme cardiaque élevé au repos (Q1 = 1281, Q2 = 1285, Q3 = 1354 et Q4 = 1416 cm/s). L’ odds ratio (95 % CI) pour le baPWV élevé dans chaque quartile du rythme cardiaque élevé au repos était 1,00 ; 1,28 (0,57–2,86) ; 2,63 (1,20–5,79) et 3,66 (1,66–8,05), après l’ajustement de l’âge, du sexe, du tabagisme, de la consommation d’alcool, de l’exercice physique, de l’indice de masse corporelle, de la prise de médicament contre l’hypertension, de la pression artérielle moyenne, de la mesure de la concentration du glucose, du cholestérol total, des triglycérides, du HDL-cholestérol, du nombre de leucocytes, de l’aspartate aminotransférase, de l’alanine aminotransférase, de la gamma glutamyl transférase et de l’acide urique.
Conclusion
Ces découvertes indiquent qu’un rythme cardiaque plus élevé au repos est indépendamment associé avec la rigidité artérielle. En conséquence, un dépistage rapide d’un rythme cardiaque plus élevé au repos est important pour la préservation de la fonction artérielle et l’évaluation du risque cardiovasculaire.
Background
Resting heart rate (HR) is a simple and useful indicator of autonomic balance and metabolic rate . Emerging evidence has shown that higher resting HR is linked closely to all-cause and cardiovascular disease mortality , but the mechanism remains unclear. Higher HR may be associated with oxidative stress and chronic subclinical inflammation because of the increased rate of oxygen consumption . Chronic low-grade arterial inflammation is known to be associated with the pathogenesis of cardiovascular disease . Several studies have reported that various inflammatory markers, such as high-sensitivity C-reactive protein, erythrocyte sedimentation rate, and white blood cell (WBC) count, are associated with arterial stiffness .
Increased arterial stiffness as measured by pulse wave velocity (PWV) has been reported to be a significant predictor of cardiovascular events and mortality . Recently, a simple, automated device has become available for the measurement of brachial-ankle pulse wave velocity (baPWV), using a volume-rendering method. Measuring baPWV is easier and more efficient than conventional measurements of aortic PWV and also has a good correlation with aortic PWV . Moreover, a previous study assessed and confirmed the validity, reliability and reproducibility of this measurement .
If the link between resting HR and cardiovascular disease morbidity and mortality is indeed mediated by chronic low-grade arterial inflammation, we would expect positive associations between resting HR and arterial stiffness. Therefore, we examined the associations of resting HR with arterial stiffness in Korean adults, as measured by baPWV.
Methods
Study population
We reviewed the medical records of 728 participants (416 men, 312 women) who underwent a medical examination at the health promotion centre in Gangnam Severance Hospital, Yonsei University College of Medicine between March 2006 and May 2007. Subjects meeting any of the following criteria were excluded ( n = 87): any missing covariate information and ankle brachial index less than 0.9; a history of arrhythmia or thyroid disease; a history of coronary heart disease or stroke. After exclusions, 641 participants (366 men, 275 women) were included in the final analysis. This study was approved by the Institutional Review Board of Yonsei University College of Medicine and informed consent was obtained from each participant. The examinations were performed by medical staff according to standard procedures. Participants were asked about lifestyle behaviour, including cigarette smoking, alcohol consumption and physical activity (more or less than two times per week), as well as whether they were currently undergoing treatments for any disease. If so, they were asked for the date of diagnosis and a list of current medications. Trained staff reviewed the completed questionnaires and entered the responses into a database. Participants were classified as non-smokers, ex-smokers or current smokers. They were also classified in terms of alcohol intake as non-drinkers or current drinkers. Body mass index was calculated as weight divided by height squared (kg/m 2 ).
After a 12-hour overnight fast, blood samples were taken from an antecubital vein. WBC counts were quantified by an automated blood cell counter (ADVIA 120, Bayer, NY, USA). Fasting plasma glucose, total cholesterol, triglycerides, high-density lipoprotein (HDL) cholesterol, aspartate aminotransferase, alanine aminotransferase, γ-glutamyltransferase and uric acid were measured using a Hitachi 7600-110 Chemistry Autoanalyzer (Hitachi, Tokyo, Japan). Diabetes was defined as a self-reported history of the disorder or a fasting plasma glucose level greater or equal to 7.0 mmol/L. Hypertension was defined as a self-reported history of the disorder, systolic blood pressure greater or equal to 140 mmHg or diastolic blood pressure greater or equal to 90 mmHg.
Definition of metabolic syndrome
The modified National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) was used for the definition of metabolic syndrome . Metabolic syndrome was defined by the presence of three or more of the following risk factors: waist circumference greater or equal to 90 cm for men and greater or equal to 80 cm for women ; high triglyceride concentration (≥ 150 mg/dL); low HDL-cholesterol concentration (< 40 mg/dL for men and < 50 mg/dL for women); elevated systolic blood pressure (≥ 130 mmHg) or elevated diastolic blood pressure (≥ 85 mmHg); high fasting plasma glucose concentration (≥ 100 mg/dL), based on the revised American Diabetes Association criteria . Subjects who reported taking antihypertensive or antidiabetic medications were considered to have elevated blood pressure or high fasting plasma glucose.
Brachial-ankle pulse wave velocity measurement
An automatic waveform analyzer (model BP-203RPE; Colin Co., Komaki, Japan) was used to measure PWV. This instrument simultaneously records venous blood pressure, phonocardiogram, electrocardiogram and arterial blood pressure at both brachial arteries and ankles. Participants were examined in the supine position after 10 minutes of bed rest. Electrocardiogram electrodes were placed on both wrists and a microphone for the phonogram was placed on the left edge of the sternum. Pneumonic cuffs were wrapped around both upper arms and ankles and connected to a plethysmographic sensor to determine the volume pulse waveform. Waveforms for the upper arm (brachial artery) and ankle (tibial artery) were stored for 10-s sample times with automatic gain analysis and quality adjustment. Oscillometric pressure sensors were attached to the cuffs to measure blood pressure in the four extremities. The baPWVs were recorded using a semiconductor pressure sensor (1200 Hz sample acquisition frequency) and calculated using the following equation:
( L a − L b ) / Δ T b a
La and Lb were defined as the distance from the aortic valve to the elbow and to the ankle, respectively. The distance from the suprasternal notch to the elbow (La) and from the suprasternal notch to the ankle (Lb) were expressed by:
L a = 0.2195 × height of participant ( cm ) − 2.0734 and L b = 0.8129 × height of participant ( cm ) + 12.328
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