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Association Between Elevated Heart Rate and Type 2 Diabetes

Mar 9, 2019
 
Editor: Joy Pape, MSN, FNP-C, CDE, WOCN, CFCN, FAADE

Author: Ghazal Blair, Pharm.D. Candidate 2019, LECOM School of Pharmacy

Increased heart rate in people with CAD has shown to increase diagnosis risk despite BMI and blood pressure.

Resting heart rate is a simple measuring factor with predictory characteristics. High resting heart may be a forecaster for mortality associated with cardiovascular disease independent of other risk factors in patients with CAD.

A representative cross-sectional survey study in 2013 was conducted to evaluate the rising incidence of diabetes and prediabetes of ethnic variation in the Chinese adult population. This study enrolled 170,287 participants. HbA1c and fasting glucose were measured in all participants. Additionally, a two-hour oral glucose tolerance test was measured in all participants who did not have diabetes.

The results from the data analysis reflected that the occurrence of diabetes among adult Chinese population is about 10.9%. Of those, 4.0% were diagnosed with diabetes with over 35% having prediabetes. Of those diagnosed with diabetes, about 36% were aware of their diagnosis and were being treated for diabetes. Out of various ethnic populations in China, those of the Tibetan and Muslim population had significantly lower incidence of diabetes. The prevalence of diabetes was greater in people who are older (P < .001), male (P < .001), city residents (P < .001), individuals living in economically developed areas (P = .003), and participant with obesity and excess weight (P < .001).

The AustDiab cohort study, published in 2012, was conducted to determine if elevated heart rate predicts the development of diabetes in a large population. The AusDiab study followed 6,537 individuals for 5 years. Out of all the participants included in the study, a total of 5,817 individuals were qualified for analysis, 221 of whom developed diabetes. Participants with a heart rate ≥ 80 b min–1 had a higher chance of developing diabetes (odds ratio 1.89, 95% CI 1.07–3.35) over 5 years.

Based on the results, this study concluded that resting heart rate is related to a higher risk of people developing diabetes over a 5-year interval, primarily amongst males of normal weight. Also, resting heart rate may be useful in predicting risk of type 2 diabetes in men of normal weight.

A recent study, published December of 2018, was conducted to investigate whether heart rate was associated with the prevalence of type 2 diabetes in a rural Chinese resident, regardless of body mass index or blood pressure. This study was a prospective cohort. Investigators used Cox proportional hazard models to examine the relation between heart rate and type 2 diabetes. They included 53,817 participants who did not have any history of type 2 diabetes, cancer, and heart disease. Height, weight, waist circumference, heart rate, and blood pressure were collected from the participants. For the purpose of this study, elevated blood pressure was defined as systolic blood pressure greater or equal to 140mmHg and diastolic blood pressure greater or equal to 90mmHg, as well as if participants were taking antihypertensive medications. The time to exit the study was defined as the time when the participants were either diagnosed with type 2 diabetes or if the individual passed away or decided to withdraw from the study. Heart rates<80 b.p.m. and ≥80 b.p.m were considered to be “Resting heart rate.”

The prevalence rate of 1,000 person-years for type 2 diabetes was calculated based on the number of new patients who recently were diagnosed divided by the total number of divided contributed person-years by all participants. For statistical analysis, they used descriptive statistics and mean ± standard deviation to define continuous variables or percentages for categorical variables.

Using Cox regression models, researchers assessed the estimated incident of type 2 diabetes, increasing quintiles of heart rate, and multiplicative interaction term of heart rate with either BMI or hypertension.

The results showed that over the mean 6.9 years of follow-up time, a total of 1,766 people developed type 2 diabetes, with a prevalence of 4.75 for every 1,000 person-years. Furthermore, data analysis suggested that people with a higher heart rate more likely had higher BMI and blood pressures. Hazard ratios for type 2 diabetes participant (multivariable‐adjusted) were 1.24 (95% CI 1.05–1.45) for those with a heart rate of 67–73 b.p.m., 1.21 (95% CI 1.03–1.41) for those with a heart rate of 73–80 b.p.m., 1.24 (95% CI 1.05–1.47) for those with a heart rate of 80–86 b.p.m., and 1.49 (95% CI 1.28–1.74) for those with a heart rate >86 b.p.m. For every 12 b.p.m increase in heart rate, the incident of type 2 diabetes increased significantly by 13%. These results indicated that there was a positive relation between increased heart rate and development of diabetes (trending p<0001).

This study concluded that elevated heart rate is correlated with a greater risk of developing type 2 diabetes without regards to BMI or blood pressure.

Practice Pearls:

  • Heart rate is an indicator of autonomic nervous system and cardiovascular function, which both relate to incident diabetes.
  • Resting heart rate may be useful in predicting risk of type 2 diabetes in adults who don’t haveexcess weight or obesity.
  • Though high BMI and elevated blood pressure are considered risk factors for development of diabetes, elevated heart rate may also increase the risk of development of type 2 diabetes, independently from other risk factors.

References:

Wang, Limin et al. “Prevalence and Ethnic Pattern of Diabetes and Prediabetes in China in 2013” JAMA vol. 317,24 (2017): 2515-2523.

Grantham NM, Magliano DJ, Tanamas SK, et al. Higher heart rate increases risk of diabetes among men: the Australian diabetes obesity and lifestyle (AusDiab) study. Diabet Med 2013; 30: 421–427.

Xu, Chunxiao, et al. “Independent and Interactive Associations of Heart Rate and Body Mass Index or Blood Pressure with Type 2 Diabetes Mellitus Incidence: A Prospective Cohort Study.” Journal of Diabetes Investigation, Feb. 2019, doi:10.1111/jdi.12999.

Ghazal Blair, Pharm.D. Candidate 2019, LECOM School of Pharmacy