In the Journals

Higher heart rates related to type 2 diabetes risk in normal-weight adults

The risk for developing type 2 diabetes is higher for Chinese adults with increased heart rates, even those in the high normal range, compared with those with lower rates, especially in combination with a BMI of less than 24 kg/m2, according to findings published in the Journal of Diabetes Investigation.

“Recent epidemiological studies showed that the association between increased heart rate and the occurrence of cardiovascular events among adults was independent of high systolic blood pressure, physical activity level and increased waist circumference, suggesting that heart rate can be recognized as an independent risk factor of CVD,” Zhengming Chen, DPhil, professor of epidemiology and director of China programs at the Nuffield Department of Population Health at the University of Oxford in the U.K., and colleagues wrote. “Resting heart rate might be directly associated with the development of diabetes.”

Chen and colleagues conducted a prospective cohort study of 53,817 adults (58.1% women; mean age of women, 51.4 years; mean age of men, 52.8 years) from the China Kadoorie Biobank study, which recruited participants from Zhejiang province in China between 2004 and 2008. Participants were followed until Jan. 1, 2014, with demographics and health history attained via questionnaire at baseline. Heart rate, BP and BMI were recorded at baseline as well. During follow-up, vital status was confirmed by use of the China CDC’s Disease Surveillance Points System and the China National Health Insurance System. Diabetes diagnoses were confirmed through established disease registries and the China National Health Insurance System.

During follow-up, 1,766 participants were diagnosed with type 2 diabetes. The researchers found that heart rate was correlated with type 2 diabetes incidence, as those with heart rates of more than 86 beats per minute (bpm; HR = 1.49; 95% CI, 1.28-1.74), 80 bpm to 86 bpm (HR = 1.24; 95% CI, 1.05-1.47), 73 bpm to 80 bpm (HR = 1.21; 95% CI, 1.03-1.41) and 67 bpm to 73 bpm (HR = 1.24; 95% CI, 1.05-1.45) were all at greater risk for developing diabetes than those with heart rates of 67 bpm or lower. The researchers also found a 13% increase in type 2 diabetes incidence for each 12-bpm rise in heart rate (HR = 1.13; 95% CI, 1.08-1.18).

In addition, the researchers noted a positive dose relationship between heart rate and type 2 diabetes (P < .001). The relationship between heart rate and type 2 diabetes was especially apparent in participants with a BMI of 24 kg/m2 or lower, including those with heart rates of 67 bpm to 73 bpm (HR = 1.51; 95% CI, 1.14-2.01), 73 bpm to 80 bpm (HR = 1.48; 95% CI, 1.12-1.95), 80 bpm to 86 bpm (HR = 1.61; 95% CI, 1.19-2.17) and more than 86 bpm (HR = 2.22; 95% CI, 1.69-2.92). The relationship was still present for participants with systolic BP of 140 mm Hg or more and diastolic BP of 90 mm Hg or more, especially in those with heart rates of more than 86 bpm (HR = 1.38; 95% CI, 1.13-1.67).

“Taken together, these results show that the incidence of type 2 diabetes mellitus associated with increased heart rate is not only statistically significant, but also clinically relevant, and that participants with a higher BMI and higher resting heart rate might require more regular glucose screening and aggressive interventions,” the researchers wrote. “Although these findings suggest sympathetic nerve activation as a driver of type 2 diabetes mellitus development, we do not recommend [beta]-blocker use in patients with hypertension, because it might result in elevated rates of diabetes onset, especially with diuretics.” – by Phil Neuffer

Disclosures: The authors report no relevant financial disclosures.

The risk for developing type 2 diabetes is higher for Chinese adults with increased heart rates, even those in the high normal range, compared with those with lower rates, especially in combination with a BMI of less than 24 kg/m2, according to findings published in the Journal of Diabetes Investigation.

“Recent epidemiological studies showed that the association between increased heart rate and the occurrence of cardiovascular events among adults was independent of high systolic blood pressure, physical activity level and increased waist circumference, suggesting that heart rate can be recognized as an independent risk factor of CVD,” Zhengming Chen, DPhil, professor of epidemiology and director of China programs at the Nuffield Department of Population Health at the University of Oxford in the U.K., and colleagues wrote. “Resting heart rate might be directly associated with the development of diabetes.”

Chen and colleagues conducted a prospective cohort study of 53,817 adults (58.1% women; mean age of women, 51.4 years; mean age of men, 52.8 years) from the China Kadoorie Biobank study, which recruited participants from Zhejiang province in China between 2004 and 2008. Participants were followed until Jan. 1, 2014, with demographics and health history attained via questionnaire at baseline. Heart rate, BP and BMI were recorded at baseline as well. During follow-up, vital status was confirmed by use of the China CDC’s Disease Surveillance Points System and the China National Health Insurance System. Diabetes diagnoses were confirmed through established disease registries and the China National Health Insurance System.

During follow-up, 1,766 participants were diagnosed with type 2 diabetes. The researchers found that heart rate was correlated with type 2 diabetes incidence, as those with heart rates of more than 86 beats per minute (bpm; HR = 1.49; 95% CI, 1.28-1.74), 80 bpm to 86 bpm (HR = 1.24; 95% CI, 1.05-1.47), 73 bpm to 80 bpm (HR = 1.21; 95% CI, 1.03-1.41) and 67 bpm to 73 bpm (HR = 1.24; 95% CI, 1.05-1.45) were all at greater risk for developing diabetes than those with heart rates of 67 bpm or lower. The researchers also found a 13% increase in type 2 diabetes incidence for each 12-bpm rise in heart rate (HR = 1.13; 95% CI, 1.08-1.18).

In addition, the researchers noted a positive dose relationship between heart rate and type 2 diabetes (P < .001). The relationship between heart rate and type 2 diabetes was especially apparent in participants with a BMI of 24 kg/m2 or lower, including those with heart rates of 67 bpm to 73 bpm (HR = 1.51; 95% CI, 1.14-2.01), 73 bpm to 80 bpm (HR = 1.48; 95% CI, 1.12-1.95), 80 bpm to 86 bpm (HR = 1.61; 95% CI, 1.19-2.17) and more than 86 bpm (HR = 2.22; 95% CI, 1.69-2.92). The relationship was still present for participants with systolic BP of 140 mm Hg or more and diastolic BP of 90 mm Hg or more, especially in those with heart rates of more than 86 bpm (HR = 1.38; 95% CI, 1.13-1.67).

“Taken together, these results show that the incidence of type 2 diabetes mellitus associated with increased heart rate is not only statistically significant, but also clinically relevant, and that participants with a higher BMI and higher resting heart rate might require more regular glucose screening and aggressive interventions,” the researchers wrote. “Although these findings suggest sympathetic nerve activation as a driver of type 2 diabetes mellitus development, we do not recommend [beta]-blocker use in patients with hypertension, because it might result in elevated rates of diabetes onset, especially with diuretics.” – by Phil Neuffer

Disclosures: The authors report no relevant financial disclosures.