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Updated: Aug 13, 2025

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Published on: June 20, 2020
Prolongation of the heart rate-corrected QT interval is associated with cardiovascular diseases: Systematic review
Sabrina J G C Welten1, Petra J M Elders1, Sharon Remmelzwaal2
1Department of General Practice, Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, 1081 BT Amsterdam, The Netherlands; Health Behaviours & Chronic Diseases, Amsterdam Public Health Research Institute, 1081 BT Amsterdam, The Netherlands.
Background:
Conflicting findings have described the association between prolonged heart rate-corrected QT interval (QTc) and cardiovascular disease.
Aims:
To identify articles investigating the association between QTc and cardiovascular disease morbidity and mortality, and to summarize the available evidence for the general and type 2 diabetes populations.
Methods:
A systematic search was performed in PubMed and Embase in May 2022 to identify studies that investigated the association between QTc prolongation and cardiovascular disease in both the general and type 2 diabetes populations. Screening, full-text assessment, data extraction and risk of bias assessment were performed independently by two reviewers. Effect estimates were pooled across studies using random-effect models.
Results:
Of the 59 studies included, 36 qualified for meta-analysis. Meta-analysis of the general population studies showed a significant association for: overall cardiovascular disease (fatal and non-fatal) (hazard ratio [HR] 1.68, 95% confidence interval [CI] 1.33-2.12; I2=69%); coronary heart disease (fatal and non-fatal) in women (HR 1.27, 95% CI 1.08-1.50; I2=38%; coronary heart disease (fatal and non-fatal) in men (HR 2.07, 95% CI 1.26-3.39; I2=78%); stroke (HR 1.59, 95% CI 1.29-1.96; I2=45%); sudden cardiac death (HR 1.60, 95% CI 1.14-2.25; I2=68%); and atrial fibrillation (HR 1.55, 95% CI 1.31-1.83; I2=0.0%). No significant association was found for cardiovascular disease in the type 2 diabetes population.
Conclusion:
QTc prolongation was associated with risk of cardiovascular disease in the general population, but not in the type 2 diabetes population.
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