부산대학교 도서관

Background:The prognostic significance of temporal changes in resting heart rate (RHR) in young adults for premature heart failure (HF) and cardiovascular disease (CVD) is not well-studied.Methods:We examined 4343 Coronary Artery Risk Development in Young Adults (CARDIA) Study participants aged 23-35 years(y) at Y5 (1990-1991) who had a contemporaneous assessment of RHR, echocardiograms, and long-term follow-up for outcomes. Cox proportional hazard models using single-occasion RHR (Y5) and temporal change in RHR (Y0 to Y5) as explanatory variables assessed associations with incident HF and CVD. Multivariable linear regression models were used to assess relations with CVD risk factors and cardiac structure and function.Results:Mean age was 29.9?3.6 years (Y5), 49% were Men, and 45% were African-American. There were 268 CVD events observed over a median follow-up of 26 years and 107991 person-years at risk. In Cox models, there was a near linear relation between temporal change in RHR and clinical outcomes. For each 1SD increment, longitudinal increases in RHR were associated with a higher risk of HF (HR=1.39 95% CI [1.09-1.78]) and CVD (HR=1.21 95% CI [1.06-1.37]). Temporal decreases in RHR were also associated with a lower risk of both HF and CVD. Single-occasion RHR was associated with CVD, but not with HF. Greater longitudinal increases in RHR were associated with higher alcohol consumption (?=0.03, p<0.001), lower physical activity (?=0.002, p=001), current smoking (? =1.58, p<0.001), Men (p<0.001), African-Americans (p<0.001), impaired left ventricular (LV) relaxation (e??= -0.13, p=0.002), and worse LV diastolic function (E/E? ? =0.1, p=0.01).Conclusions:Temporal changes in RHR in young adults were associated with incident HF and CVD in middle age and provided additional information to a single occasion RHR. Contributory factors were relations between secular changes in RHR and early suboptimal CVD risk factors and subsequent cardiac dysfunction.