title: Resting heart rate and the risk of microvascular complications in patients with type 2 diabetes mellitus.
abstract: BACKGROUND
  A higher resting heart rate is associated with an increased probability of cardiovascular complications and premature death in patients with type 2 diabetes mellitus. The impact of heart rate on the risk of developing microvascular complications, such as diabetic retinopathy and nephropathy, is, however, unknown. The present study tests the hypothesis that a higher resting heart rate is associated with an increased incidence and a greater progression of microvascular complications in patients with type 2 diabetes mellitus.
  
  
  RESULTS
  The relation between baseline resting heart rate and the development of a major microvascular event 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. Major microvascular events were defined as a composite of new or worsening nephropathy or new or worsening retinopathy. Patients with a higher baseline heart rate were at increased risk of a new major microvascular complication during follow-up (adjusted hazard ratio: 1.13 per 10 beats per minute; 95% confidence interval: 1.07-1.20; P<0.001). The excess hazard was evident for both nephropathy (adjusted hazard ratio: 1.16 per 10 beats per minute; 95% confidence interval: 1.08-1.25) and retinopathy (adjusted hazard ratio: 1.11 per 10 beats per minute; 95% confidence interval: 1.02-1.21).
  
  
  CONCLUSIONS
  Patients with type 2 diabetes mellitus who have a higher resting heart rate experience a greater incidence of new-onset or progressive nephropathy and retinopathy.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT00145925. http://www.advance-trial.com/static/html/prehome/prehome.asp.
authors: The George Institute for Global Health, University of Sydney, Australia. ghillis@georgeinstitute.org.au
authors: Graham S
authors: GS
authors: Hillis
authors: Jun
authors: J
authors: Hata
authors: Mark
authors: M
authors: Woodward
authors: Vlado
authors: V
authors: Perkovic
authors: Hisatomi
authors: H
authors: Arima
authors: Clara K
authors: CK
authors: Chow
authors: Sophia
authors: S
authors: Zoungas
authors: Anushka
authors: A
authors: Patel
authors: Neil R
authors: NR
authors: Poulter
authors: Giuseppe
authors: G
authors: Mancia
authors: Bryan
authors: B
authors: Williams
authors: John
authors: J
authors: Chalmers
mesh_terms: D000368:Aged; D048909:Diabetes Complications / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000503:physiopathology; D003925:Diabetic Angiopathies / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate; D006801:Humans; D015994:Incidence; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D012306:Risk; D013610:Tachycardia / Q000150:complications*
keywords: diabetes mellitus, type 2; heart rate; microcirculation