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A higher resting heart rate is associated with cardiovascular event risk in patients with type 2 diabetes mellitus without known cardiovascular disease

Hypertension Research volume 46, pages 1090–1099 (2023)Cite this article

A Comment to this article was published on 08 March 2023

Abstract

A higher resting heart rate (RHR) is associated with an increased risk of cardiovascular events in patients with type 2 diabetes mellitus (T2DM) and cardiovascular diseases. The aim of this study was to investigate the association between RHR and cardiovascular events in T2DM patients with diabetic retinopathy and without known cardiovascular disease. We analyzed the association between RHR and cardiovascular events, including coronary, cerebral, renal and vascular events or cardiovascular death in T2DM patients with retinopathy and hyperlipidemia without prior cardiovascular events who were enrolled in the EMPATHY study. Data from 4746 patients were analyzed. The median RHR was 76 bpm. Patients were divided into four groups based on their baseline RHR ( < 60, 60–69, 70–79, and ≥80 bpm). Patients with a higher RHR were more likely to be younger and had a higher body mass index, blood pressure value, HbA1c value, and estimated glomerular filtration rate and a lower B-type natriuretic peptide value; they also had a higher proportion of current smoking status, neuropathy, and nephropathy. After adjusting for confounders, including the aforementioned risk factors, a RHR of 70–79 bpm and a RHR ≥ 80 bpm were significantly associated with cardiovascular events (hazard ratio 1.50, 95% CI 1.03–2.20; and hazard ratio 1.62, 95% CI 1.11–2.36; respectively) compared to a RHR of 60–69 bpm. The analysis using restricted cubic splines indicated that the cardiovascular risk seemed to be similarly high when the RHR range was ≥70 bpm. In conclusion, in T2DM patients with diabetic retinopathy and without known cardiovascular disease, a high RHR, particularly ≥70 bpm, was associated with the risk of cardiovascular events compared to a RHR of 60–69 bpm.

High resting heart rate (RHR), particularly ≥70 bpm, was associated with the risk of cardiovascular events compared to RHR 60-69 bpm in patients with type 2 diabetes mellitus (T2DM), diabetic retinopathy, and hyperlipidemia, but without known cardiovascular disease.

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan

    Shota Ikeda, Keisuke Shinohara, Nobuyuki Enzan, Shouji Matsushima, Takeshi Tohyama, Kouta Funakoshi & Hiroyuki Tsutsui

  2. Center for Clinical and Translational Research, Kyushu University Hospital, Fukuoka, Japan

    Takeshi Tohyama, Kouta Funakoshi & Junji Kishimoto

  3. Department of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, Tokyo, Japan

    Hiroshi Itoh

  4. Department of Cardiovascular Medicine, The University of Tokyo Graduate School of Medicine, Tokyo, Japan

    Issei Komuro

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KS reports grants from Daiichi Sankyo, Nippon Boehringer Ingelheim, and Otsuka Medical Devices. HI reports personal fees from SBI Pharmaceuticals, Wakunaga Pharmaceutical, NIPRO, Meiji, Taisho Pharmaceutical, Ono Pharmaceutical, Kowa, Takeda Pharmaceutical, Daiichi Sankyo, and Novartis Pharma. IK reports grants and/or personal fees from Idorsia Pharmaceuticals Japan, Daiichi Sankyo, Takeda Pharmaceutical, Mitsubishi Tanabe Pharma, Teijin Pharma, AstraZeneca, Kowa, MSD, Otsuka Pharmaceutical, Ono Pharmaceutical, Nippon Boehringer Ingelheim, Novartis Pharma, and Bayer Yakuhin. HT reports grants and/or personal fees from Daiichi Sankyo, Novartis Pharma, Otsuka Pharmaceutical, Pfizer Japan, Mitsubishi Tanabe Pharma, Teijin Pharma, Nippon Boehringer Ingelheim, AstraZeneca, Ono Pharmaceutical, Kowa, IQVIA Service Japan, MEDINET, Medical Innovation Kyushu, Bayer Yakuhin, Johnson & Johnson, NEC, Nippon Rinsho and Japanese Heart Failure Society. Other authors report no conflicts of interest.

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Ikeda, S., Shinohara, K., Enzan, N. et al. A higher resting heart rate is associated with cardiovascular event risk in patients with type 2 diabetes mellitus without known cardiovascular disease. Hypertens Res 46, 1090–1099 (2023). https://doi.org/10.1038/s41440-023-01178-1

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