摘要：Objectives. This study sought to verify the independent role of heart rate in the prediction of all-cause, cardiovascular, and noncardiovascular mortality in a low-risk male population. Methods. In an Italian population-based observational study, heart rate was measured in 2533 men, aged 40 to 69 years, between 1984 and 1993. Data on cardiovascular risk factors were collected according to standardized procedures. Vital status was updated to December 1997. Results. Of 2533 men followed up (representing 24 457 person-years), 393 men died. Age-adjusted death rates for 5 heart rate levels showed increasing trends. The adjusted hazard rate ratios for each heart rate increment were 1.52 (95% confidence interval [CI] = 1.29, 1.78) for all-cause mortality, 1.63 (95% CI = 1.26, 2.10) for cardiovascular mortality, and 1.47 (95% CI = 1.19, 1.80) for noncardiovascular mortality. Relative risks between extreme levels were more than 2-fold for all endpoints considered. Conclusions. Heart rate is an independent predictor of cardiovascular, noncardiovascular, and total mortality in this Italian middle-aged male population. A direct association of elevated heart rate with hypertension, hypercholesterolemia, and hyperglycemia and an inverse relationship with physical activity and pulmonary function have been found in several epidemiologic studies. 1 – 11 Tachycardia precedes hypertension, increases risk of arrhythmia, and facilitates the development of atherosclerotic plaque. 8 , 9 , 12 All-cause mortality seems to be higher in individuals with elevated heart rates. In the Framingham Study, death rates increased with increasing levels of heart rate; the association was stronger in men and not related to age, and there was no indication of a threshold value that could be defined as hazardous. 13 , 14 Among individuals with hypertension, a positive association between heart rate and cardiovascular diseases, particularly coronary heart disease and sudden death, has also been shown even after exclusion of early deaths, confirming that heart rate is an independent predictor of fatal events and not only an indicator of preexisting illness. 15 The National Health and Nutrition Examination Survey, the Paris Prospective Study, the Spandau Health Test, and the 3 Chicago epidemiologic studies have also revealed a positive association between heart rate and cardiovascular and noncardiovascular mortality. 6 , 7 , 16 – 20 These findings represent evidence that heart rate can be considered a determinant of health status and a predictor of poor outcomes in the general population. Despite the amount of international evidence, mainly from Northern European and US studies, that heart rate is a health determinant, the prognostic role of heart rate in mortality has not been assessed in Mediterranean populations. Among these groups, other risk factors, such as dietary intake, serum cholesterol, and body mass index, have been shown to have unique relations to total mortality and fatal coronary events. 21 – 23 In the present study, we evaluated the association of heart rate with all-cause, cardiovascular, and noncardiovascular mortality among a sample of middle-aged men residing in central Italy.
