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Diabetes, heart rate, and mortality
1Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA.
Insights
A persistently high heart rate increases mortality risk across various cardiovascular conditions and the general population. Slowing heart rate, particularly with beta-blockers, may improve survival in heart failure and post-myocardial infarction patients.
Area of Science:
- Cardiology
- Clinical Medicine
- Pharmacology
Background:
- Elevated heart rate is a known risk factor for mortality in diverse cardiovascular disorders and the general population.
- Conditions like hypertension, myocardial infarction, and impaired cardiac function are associated with increased mortality risk linked to high heart rate.
- Autonomic neuropathy in diabetes mellitus can also lead to persistently elevated heart rate.
Purpose of the Study:
- To review existing evidence on the role of elevated heart rate as a mortality risk factor.
- To examine the therapeutic implications of heart rate modulation in cardiovascular disease management.
- To explore whether elevated heart rate in diabetes mellitus is an independent mortality risk factor.
Main Methods:
- Systematic review of existing scientific literature and data.
- Analysis of epidemiological studies and clinical trial outcomes.
- Examination of pharmacological interventions affecting heart rate, such as beta-adrenergic blocking drugs.
Main Results:
- Consistent evidence links persistently high heart rate to increased mortality risk.
- Pharmacological reduction of heart rate, especially with beta-blockers, is associated with improved survival in specific patient groups (e.g., post-myocardial infarction, heart failure).
- The independent mortality risk of elevated heart rate in diabetes mellitus requires further definition.
Conclusions:
- Persistently elevated heart rate is a significant risk factor for mortality across multiple conditions.
- Therapeutic strategies aimed at reducing heart rate may offer survival benefits.
- Further research is needed to clarify the role of elevated heart rate in diabetes-related mortality.
Abstract:
A large body of evidence indicates that a persistently high heart rate is associated with a significant risk for higher mortality and sudden death in individuals with a variety cardiovascular disorders, as well as in the general population. Heart rates elevated beyond a certain threshold have been found to be a risk factor for mortality in patients with hypertension, in survivors of myocardial infarction, and in patients with impaired cardiac function. Conversely, a naturally slow heart rate, or one that is slow by virtue of sympathetic blockade induced by pharmacologic agents, may result in longer survival. This is particularly evident in the case of beta-adrenergic blocking drugs, especially in patients after myocardial infarction and in those with acute as well as chronic cardiac failure, a syndrome in which there is a complex neurohormonal disturbance with elevated heart rate. Persistently elevated heart rate is also a feature of diabetes mellitus associated with autonomic neuropathy. Whether this also constitutes an independent risk factor for sudden and augmented mortality is not well defined. In this review, the data on the role of increased heart rate as a risk factor for mortality are examined in the context of other factors that may have therapeutic implications.