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Diabetes: At what resting heart rate does the risk of cardiovascular events increase?
Piotr Sobieraj1, Jacek Lewandowski2, Maciej Siński2
1Department of Internal Medicine, Hypertension and Vascular Diseases, Medical University of Warsaw, Warszawa, Poland. piotr.sobieraj@wum.edu.pl.
Insights
Elevated resting heart rate (RHR) increases cardiovascular risk in diabetes patients. A threshold of 77 bpm, not 80 bpm, may better identify those at higher risk for events like stroke.
Area of Science:
- Cardiology
- Endocrinology
- Clinical Research
Background:
- Elevated resting heart rate (RHR) is a known risk factor for cardiovascular (CV) events and mortality.
- Current guidelines suggest an RHR of 80 bpm as a threshold for increased CV risk, but evidence is inconclusive.
Purpose of the Study:
- To examine the association between RHR and CV risk in individuals with diabetes mellitus (DM).
- To determine a specific RHR threshold indicative of significantly increased CV risk in this population.
Main Methods:
- Post hoc analysis of the ACCORD-BP trial data (4733 participants with DM).
- Stratification of patients into RHR categories and use of Cox proportional hazards models with restricted cubic splines and segmented regression.
- Evaluation of RHR's relationship with a composite CV endpoint (myocardial infarction, stroke, death) and secondary CV endpoints.
Main Results:
- A nonlinear relationship was observed between higher RHR and increased CV risk.
- Segmented regression identified a significant CV event risk increase above an RHR of 77 bpm.
- Stroke risk showed the strongest association with elevated RHR; myocardial infarction risk showed a linear relationship.
Conclusions:
- An RHR threshold of approximately 77 bpm may be more appropriate than 80 bpm for identifying increased CV risk in patients with DM.
- These findings could guide clinical decisions on RHR-lowering interventions for individuals with diabetes.
Background:
Elevated resting heart rate (RHR) is associated with an increased risk of cardiovascular (CV) events, including myocardial infarction (MI), stroke, and CV mortality. Despite current guidelines suggesting an RHR threshold of 80 bpm for heightened risk and potential therapeutic intervention, evidence supporting this cut-off remains inconclusive.
Aims:
To assess the relationship between RHR and CV risk in individuals with diabetes mellitus (DM) and to identify an RHR threshold above which CV risk significantly increases.
Material And Methods:
A post hoc analysis was conducted using data from the Action to Control Cardiovascular Risk in Diabetes (ACCORD-BP) trial, which included 4733 participants with DM. Baseline RHR was used to stratify patients into RHR categories. Cox proportional hazards models, including restricted cubic splines and segmented regression, were used to evaluate the relationship between RHR and a composite CV endpoint (non-fatal MI, non-fatal stroke, or all-cause death), as well as secondary endpoints (CV death, MI, and stroke).
Results:
Higher RHR was associated with increased CV risk, with a nonlinear relationship observed. Segmented regression identified an RHR threshold of 77 (7.4) bpm, above which the risk of CV events increased significantly. Stroke risk was most strongly associated with elevated RHR, while MI exhibited a linear relationship with RHR.
Conclusions:
Our findings suggest that an RHR threshold of approximately 77 bpm may better define increased CV risk in patients with DM compared to the previously proposed 80 bpm cut-off. These results may inform clinical decision-making regarding RHR-lowering interventions in this population.
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