Observational Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Jan 15, 2018; 9(1): 33-39
Published online Jan 15, 2018. doi: 10.4239/wjd.v9.i1.33
Heart rate is an independent predictor of all-cause mortality in individuals with type 2 diabetes: The diabetes heart study
Sameer Prasada, Cameron Oswalt, Phyllis Yeboah, Georgia Saylor, Donald Bowden, Joseph Yeboah
Sameer Prasada, Cameron Oswalt, Department of Medical School (Medical students), Wake Forest University, Winston Salem, NC 27157, United States
Phyllis Yeboah, Department of Internal Medicine, Wake Forest Baptist Health, Winston Salem, NC 27157, United States
Georgia Saylor, Joseph Yeboah, Department of Heart and Vascular Center of Excellence, Wake Forest Baptist Health, Winston Salem, NC 27157, United States
Donald Bowden, Department of Biochemistry, Genomics and Personalized Medicine Research, Wake Forest University, Winston Salem, NC 27157, United States
Author contributions: Bowden D enrolled subjects and collected data for the Diabetes Heart Study; Prasada S and Yeboah J designed the study and performed statistical analysis using Statistical Analysis System JMP; Prasada S and Oswalt C wrote the manuscript; Yeboah P and Yeboah J helped write and edit the manuscript; all authors contributed to this article.
Institutional review board statement: The Diabetes Heart Study was approved by the Wake Forest University Institutional Review Board.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment in the Diabetes Heart Study (DHS).
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Joseph Yeboah, MD, MS, Department of Heart and Vascular Center of Excellence, Wake Forest Baptist Health, Medical Center Blvd, Winston Salem, NC 27157, United States. jyeboah@wakehealth.edu
Telephone: +1-336-7167015 Fax: +1-336-7169188
Received: May 4, 2017
Peer-review started: May 5, 2017
First decision: July 20, 2017
Revised: July 25, 2017
Accepted: November 25, 2017
Article in press: November 25, 2017
Published online: January 15, 2018
Research background

Individuals with type 2 diabetes mellitus have a significantly higher risk of morbidity and mortality compared with those without diabetes mellitus. Cardiovascular diseases still remains the number one cause of death in persons with diabetes mellitus. Current efforts at reducing this risk include tight glycemic control, control of cardiovascular risk factors and weight reduction among others. Despite these measures, morbidity and mortality in diabetes mellitus still remains high. There is therefore the need for identifying other non-traditional risk factors to further reduce this risk. Resting heart rate has been associated with mortality in the general population. However the association of resting heart rate and mortality risk in diabetes mellitus is unclear.

Research motivation

There are several ways (pharmacological and non-pharmacological) that resting heart rate can be reduced. Establishing an association between resting heart rate and mortality in individuals with diabetes mellitus provides a whole new avenue and pathway for further reducing the high mortality risk associated with the disease.

Research objectives

This study used a large population of individuals with diabetes mellitus.

Research methods

Heart rate was collected from baseline resting electrocardiogram and mortality (all-cause and CVD) was obtained from state and national death registry. Kaplan-Meier (K-M) and Cox proportional hazard analyses were used to assess the association.

Research results

The results show that a 1 standard deviation increase in resting heart rate is associated with a 20% increase in the risk mortality.

Research conclusions

Resting heart rate is a risk factor for all-cause and cardiovascular disease mortality in individuals with diabetes mellitus and may provide additional prognostic information.

Research perspectives

Resting heart rate is a cheap ubiquitous vital sign that is obtained during every doctor’s visit. The information gleaned from this vital sign maybe be useful to guide therapy choices which will ultimately reduce mortality in this population.