Risk of elevated resting heart rate on the development of type 2 diabetes in patients with clinically manifest vascular diseases

Abstract

Objective: Sympathetic nerve activation is causally related to insulin resistance as both a cause and a consequence. Resting heart rate (RHR) reflects sympathetic nerve activity. We investigated the effect of RHR on the incidence of type 2 diabetes mellitus (T2DM) in patients with clinically manifest vascular diseases. Design: Data were used from the second manifestations of arterial disease (SMART) study: a prospective cohort study of patients with clinically manifest vascular diseases (nZ3646). Methods: RHR was obtained using an electrocardiogram. Patients were followed up for incident type 2 diabetes (nZ289) during a median period of 5.5 (interquartile range 3.2-8.4) years. The relation between RHR and incident T2DM was estimated by Cox proportional hazard analysis. As age was an effect modifier (PZ0.048), analyses were stratified for age. Results: Patients in quartile 4 (Q4) of RHR had a 65% increased risk of T2DM compared with those in Q1 (reference; hazard ratios (HR), 1.65; 95% confidence interval (95% CI), 1.15-2.36) adjusted for age, gender, smoking, estimated glomerular filtration rate, systolic blood pressure, location of vascular disease, and antihypertensive medication. Every 10 beats per minute (bpm) increase in RHR increased the risk for T2DM with 10% (HR, 1.10; 95% CI, 1.00-1.21) in the total population. This risk was particularly high in subjects aged 55-63 years (per 10 bpm: HR, 1.22; 95% CI, 1.04-1.43) and was independent of the location of vascular disease and beta-blocker use. Conclusions: Increased RHR, an indicator of sympathetic nerve activity, is associated with an increased risk for T2DM in patients with manifest vascular diseases, particularly in middle-aged patients.

Elevated heart rate predicts β cell function in non-diabetic individuals: the RISC cohort

“…These results are in keeping with previous evidence showing that heart rate is predictive of type 2 diabetes in the general population (2,3,4,5,20). However, the precise nature of the pathophysiological relationship underlying the increased risk of hyperglycaemia in those with an elevated heart rate has not been explained.…”

“…Elevated heart rate has been associated with an increased risk of type 2 diabetes in a number of epidemiological studies (1,2,3,4,5). This association has been mainly attributed to increased insulin resistance, secondary to the activation of sympathetic nerve activity (6,7,8).…”

Resting heart rate and the risk of type 2 diabetes: A systematic review and dose–response meta-analysis of cohort studies

“…Despite this, the association between elevated resting heart rate and type 2 diabetes remains unclear (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17). Some studies suggested an increased risk of type 2 diabetes with higher heart rate (6;7;10;12-17), whereas others found the association to be no longer significant after adjustment for potential confounding factors (8;9;11).…”

Relationship between serum uric acid, metabolic syndrome and resting heart rate in Chinese elderly

“…RHR is positively associated with sub-clinical inflammation and increased RHR may also be a sign of sub-clinical heart disease [9]. It is reported that insulin resistance and elevated sympathetic nerve activity are closely linked with each other [10]. Acute reflex activation of the sympathetic nerve system could induce acute insulin resistance in humans [10].…”

“…Acute reflex activation of the sympathetic nerve system could induce acute insulin resistance in humans [10]. Moreover, chronically increased sympathetic nerve activity can precede the development of insulin resistance and obesity [10,11].…”