title: Resting heart rate and the risk of death and cardiovascular complications in patients with type 2 diabetes mellitus.
abstract: OBJECTIVE
  An association between resting heart rate and mortality has been described in the general population and in patients with cardiovascular disease. There are, however, few data exploring this relationship in patients with type 2 diabetes mellitus. The current study addresses this issue.
  
  
  METHODS
  The relationship between baseline resting heart rate and all-cause mortality, cardiovascular death and major cardiovascular events (cardiovascular death, non-fatal myocardial infarction or non-fatal stroke) was examined in 11,140 patients who participated in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) Study.
  
  
  RESULTS
  A higher resting heart rate was associated with a significantly increased risk of all-cause mortality (fully adjusted HR 1.15 per 10 bpm [95% CI 1.08, 1.21], p<0.001), cardiovascular death and major cardiovascular outcomes without adjustment and after adjusting for age and sex and multiple covariates. The increased risk associated with a higher baseline resting heart rate was most obvious in patients with previous macrovascular complications (fully adjusted HR for death 1.79 for upper [mean 91 bpm] vs lowest [mean 58 bpm] fifth of resting heart rate in this subgroup [95% CI 1.28, 2.50], p = .001).
  
  
  CONCLUSIONS
  Among patients with type 2 diabetes, a higher resting heart rate is associated with an increased risk of death and cardiovascular complications. It remains unclear whether a higher heart rate directly mediates the increased risk or is a marker for other factors that determine a poor outcome.
authors.affiliation: The George Institute for Global Health, King George V Building, Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia. ghillis@georgeinstitute.org.au
authors.forename: G S
authors.initials: GS
authors.lastname: Hillis
authors.forename: M
authors.initials: M
authors.lastname: Woodward
authors.forename: A
authors.initials: A
authors.lastname: Rodgers
authors.forename: C K
authors.initials: CK
authors.lastname: Chow
authors.forename: Q
authors.initials: Q
authors.lastname: Li
authors.forename: S
authors.initials: S
authors.lastname: Zoungas
authors.forename: A
authors.initials: A
authors.lastname: Patel
authors.forename: R
authors.initials: R
authors.lastname: Webster
authors.forename: G D
authors.initials: GD
authors.lastname: Batty
authors.forename: T
authors.initials: T
authors.lastname: Ninomiya
authors.forename: G
authors.initials: G
authors.lastname: Mancia
authors.forename: N R
authors.initials: NR
authors.lastname: Poulter
authors.forename: J
authors.initials: J
authors.lastname: Chalmers
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality; D002423:Cause of Death; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000401:mortality*; D003925:Diabetic Angiopathies / Q000209:etiology / Q000401:mortality; D058065:Diabetic Cardiomyopathies / Q000401:mortality*; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D055806:Microvessels / Q000503:physiopathology; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D012306:Risk; D020521:Stroke / Q000209:etiology