心率与肥胖和糖尿病的危险

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,*,心率与肥胖和糖尿病的危险,广东省人民医院,广东省心血管病研究所,刘小清,84,Heart rate(bpm),Incidence/1,000 men/2 Yrs,60,50,40,30,20,10,0,CHD,CVD,All-cause,Figure 16.Gillman M.W.et al.(1993).Heart J 125,1148.,心率与全因死亡、心血管病死亡和冠心病死亡的关系,the Framingham Study 前瞻性研究,heart rate:80 bpm,64-80 bpm,64 bpm,Palatini P.et al.(1999).Arch Int Med 159(6),585,All-cause mortality,Cardiovascular mortality,1.0,0.8,0.6,0.4,0,2,4,6,8,10,12,Follow-up(Yrs),1.0,0.8,0.6,0.4,0,2,4,6,8,10,12,Follow-up(Yrs),p,=0.011,p,=0.0007,心率对全因死亡和心血管病死亡的影响,人类的平均心率为70次/分左右，其预期寿命为80岁,另有观察发现将人类心率由70次/分减少到60次/分可使预期寿命增加到93.3岁,Heart rate,Beats/min,Mouse,Hampster,Ratt,Monkey,Mamot,Cat,Dog,Giratte,Horse,Elephant,Whale,Whale,Lion,Ass,Tiger,Man,herbert J,Levins,JACC Vol.30,No.4 October 1997:11046,Life expectancy,years,哺乳动物心率和寿命的关系,哺乳动物心率和寿命之间存在线性、逆向的半对数关系,尽管个体寿命、体重和心率差异很大哺乳动物一生的总心跳数目却惊人的保持对数的恒定,herbert J,Levins,JACC Vol.30,No.4 October 1997:11046,Mouse,Life expectancy,years,Beats/Lifetime,Man,Hampster,Rat,Monkey,Mamot,Cat,Dog,Giratte,Horse,Elephan,t,Whale,Whale,Lion,Ass,Tiger,100,60,30,10,5,2,Beats/Lifetime,Weight,Kg,Man,Hampster,Rat,Monkey,Mamo,t,Cat,Dog,Giratte,Horse,Elephant,Whale,Whale,Lion,Ass,Tiger,10,5,10,4,10,3,10,2,1,10,10,-1,10,2,10,4,10,6,10,8,10,10,10,12,10,2,10,4,10,6,10,8,10,10,10,12,地高辛/天喂养的小鼠心率与寿命试验,herbert J,Levins,JACC Vol.30,No.4 October 1997:11046,P0.001,对照组,心率试验,寿命试验,地高辛组,P0.001,0,200,400,600,对照组,地高辛组,对照组,地高辛组,生存率,50%survival,850天,50%survival,700天,563beats/m,266beats/m,小鼠心率和寿命的关系,静息心率过快是高血压患者心血管病死亡的独立危险因子The Framingham study,?Harvard Heart Letter，2021.12?,静息心率较快的男性高血压发生率增加,静息心率与动脉粥样硬化、卒死和心血管 疾病死亡相关,日本心率与肥胖、糖尿病随访研究,Study population,in 1979 and 1999,a rural farming community,southwestern JapanTanushimaru,a cohort of the Seven Countries Study),Yoshiyuki Shigetoh1,Am J Hypertens 2021;22:151-155,日本心率与肥胖、糖尿病随访研究,a complete dataset of,614,subjects,224 men and 390 women,Yoshiyuki Shigetoh1,Am J Hypertens 2021;22:151-155,结 果,人群基线(1979)及随访(1999)特征,Parameters 1979(Mean)1999(Mean),(range)(range),P,value,Number 614 614,Age(years)43.2(2171)62.7(4190)0.01,Body weight(kg)55.9(3790)56.2(31104)0.32,BMI(kg/m2)22.7(16.040.9)23.2(15.537.1)0.01,Heart rate(beats/min)67(40108)63(40106)0.01,SBP(mm Hg)126(88204)139(90222)0.01,DBP(mm Hg)74(48140)82(52124)0.01,TC(mg/dl)182.9(72325)201.5(107317)0.01,HDL-c(mg/dl)48.1(2291)56.5(22171)0.01,TG(mg/dl)103.6(20.9555.6)96.0(27.9473.4)0.01,FPG(mg/dl)95.7(54.1270.4)95.0(68.0208.5)0.54,Yoshiyuki Shigetoh1,Am J Hypertens 2021;22:151-155,结 果,人群基线(1979)及随访(1999)特征,Parameters 1979(Mean)1999(Mean),(range)(range),P,value,Number 614 614,Estimated GFR(ml/min)71.4(27.8146.9)67.2(16.6151.7)0.01,Uric acid(mg/dl)4.3(0.59.2)4.9(0.211.2)0.01,Waist(cm)NA 77(55105),FFA(mEq/l)NA 0.6(0.11.7),Hemoglobin A1c(%)NA 5.2(3.810.8),Insulin(U/ml)NA 4.7(1.215.6),Frequency,Sex:men(%)224(36)224(36),Smoking:yes(%)192(31.3)83(13.5)0.01,Alcohol intake:(%)128(20.8)111(18.1)0.08,Medication:yes(%),Hypertension,0(0.0)116(18.9),Diabetes mellitus NA 8(1.3),Hyperlipidemia NA 27(4.4),Yoshiyuki Shigetoh1,Am J Hypertens 2021;22:151-155,结 果,按照心率不同分为四组,60 bpm,6069 bpm,7079 bpm,80 bpm,控制变量：性别、年龄,Yoshiyuki Shigetoh1,Am J Hypertens 2021;22:151-155,心率与各变量的方差分析控制变量：性别、年龄,Yoshiyuki Shigetoh1,Am J Hypertens 2021;22:151-155,Heart rate,60,6069,70 79,80,value,Number,216,262,100,36,SBP(mm Hg),135(1.4),138(1.3),146(2.1),150(3.4),0.01,DBP(mm Hg),79(0.8),81(0.7),86(1.2),89(2.0),0.01,FFA(mEq/l),0.56(0.02),0.60(0.02),0.69(0.02),0.77(0.04),0.01,FPG(mg/dl),93.2(1.0),94.4(1.0),100.9(1.0),97.6(1.0),0.01,HOMA index,1.0(1.0),1.1(1.0),1.3(1.1),1.3(1.1),0.01,HT medication%,14.4,16.8,27.0,46.1,0.01,不同心率组OR值及,95%CI,Yoshiyuki Shigetoh1,Am J Hypertens 2021;22:151-155,Heart rate,60,6069,70 79,80,Number,127,270,166,51,Obesity,ref,0.65(0.351.23),0.66(0.321.35),2.34(1.095.90)*,Abdominal obesity,ref,1.47(0.733.01),1.18(0.512.75),1.91(0.936.05),Hypertension,ref,1.38(0.335.73),1.61(0.357.36),1.95(0.358.36),Hypercholesterolemia,ref,0.69(0.421.15),0.87(0.511.49),1.11(0.532.32),Insulin resistance,ref,1.35(0.782.32),1.15(0.632.11),2.20(1.045.07)*,DM,ref,2.15(0.686.76),2.91(0.899.53),5.39(1.3421.8)*,控制变量：性别、年龄、,BMI 和 FPG,以心率60 bpm 为参照组,调整因素为年龄、性别、BMI 和 FPG,与心率65岁的老年人中，基线心率每增加12次/分那么患糖尿病的危险性增加10,在3549岁人群中尚观察到过快的基线心率与糖尿病死亡有关,Chicago Heart Association Detection Project,Carnethon MR，Diabetes Care.2021;31(2):335-9,心率与死亡相关的原因,心脏的每次射血都对动脉壁产生轻微的冲击，心率越快这种冲击越多,心率加快 冠脉充盈时间减少 心脏细胞需氧和供氧失衡,?Harvard Heart Letter，2021.12?,心率与肥胖相关原因,心率受到交感神经系统调节,心率影响 大肠、血管、瞳孔扩张、排汗和血压,过多的神经活动 身体脂肪的燃烧量 肥胖,Yoshiyuki Shigetoh1,Am J Hypertens 2021;22:151-155,高血压,/,代谢综合症患者的交感神经活性,69,例肥胖患者,N,C,E,H,T,M,S,-,E,H,T,M,S,+,E,H,T,80,60,40,20,0,P0.05,P0.01,P0.001,Sympathetic,activity,(impulses/,100 heart,beats),Huggett et al,Hypetens.2004,2,型糖尿病合并高血压患者交感神经活性明显增加,配对病例对照研究,110,100,90,80,70,60,50,40,30,20,10,0,EHT+DM2,EHT,DM2,NT,P,0.001,P,0.01,P,0.001,P,0.001,Sympathetic,Activity,(Impulses/,100 beats),降低静息心率的方法,增加运动：运动时心率暂时加快，但长期坚持每天规律运动可以降低静息心率。,减少压力应急：放松、冥想等,?Harvard Heart Letter，2021.12?,2,型糖尿病,高血压患者,受体阻断对心血管事件的影响,UKPDS,N=1148,follow-up 9 years,(RR