Heart Rate Recovery Following Exercise as a Predictor of Cardiovascular Disease and Mortality in Men With Diabetes

Attenuated heart rate recovery (HRR) following maximal exercise test is a predictor of mortality in healthy adults and in those referred for diagnostic testing

Regular exercise training may improve HRR in healthy individuals and in patients with congestive heart failure or diabetes. Regular exercise also improves markers of glucose metabolism. We have previously described a strong, inverse association between cardiorespiratory fitness and 12-year mortality in a cohort of 1,263 men with documented type 2 diabetes. The purpose of the current research was to evaluate whether slow HRR after maximal exercise predicts cardiovascular disease (CVD) and all-cause mortality among these diabetic men.

Heart rate recovery (HRR) is an independent prognostic indicator for cardiovascular disease (CVD) and all-cause mortality in healthy men. We examined the association of HRR to CVD-related and all-cause mortality in men with diabetes.

In this cohort study we examined 2,333 men with documented diabetes (mean age 49.4 years) that had baseline 5-min HRR measurement following maximal exercise (heart ratepeak - heart rate5 min of recovery) at The Cooper Clinic, Dallas, TX.
The results showed that during a median of 14.9 years follow-up, there were 142 deaths that were considered CVD related and 287 total deaths.

We found that lower HRR measured even as long as 5 min following maximal exercise was independently associated with higher CVD and all-cause mortality in men with diabetes. This association persisted even after accounting for age, cardiorespiratory fitness, prior CVD, and other possible confounders. Our findings have shown strong associations between mortality and impaired HRR in adults referred for symptom-limited exercise testing and thallium scintigraphy for diagnostic purposes, but to our knowledge our results are the first to show this association in patients with diabetes. It is important to note, however, that HRR was not the strongest predictor of risk. Therefore, when assessing risk in men with diabetes, it should not be used alone but rather in conjunction with other strong predictors, such as cardiorespiratory fitness.
Evidence from this study suggests that HRR is an independent predictor of CVD and all-cause mortality from cardiorespiratory fitness.

In conclusion, men with diabetes who had slow HRR at 5 min following a maximal exercise test had a higher risk of CVD and all-cause mortality when compared with similar men who had more rapid HRR. The high risk in men with slow HRR persisted after adjustment for cardiorespiratory fitness, baseline prevalence of CVD, and other potential confounding variables. The results of our study suggest that the exercise test, which is simple, safe, and inexpensive, can be used as a powerful tool for clinical risk stratification in diabetic men by noting both HRR and cardiorespiratory fitness.

Among men with diabetes, a decreased HRR, even measured as long as 5 min after recovery, was independently predictive of cardiovascular and all-cause death. Diabetes Care 26:2052-2057, 2003

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