title: Resting heart rate and the risk of type 2 diabetes: A systematic review and dose--response meta-analysis of cohort studies.
abstract: BACKGROUND
  High resting heart rate has been associated with increased risk of type 2 diabetes in several studies, but the available data are not consistent and it is unclear if there is a dose-response relationship between resting heart rate and type 2 diabetes risk. We aimed to clarify this association by conducting a systematic review and meta-analysis of published studies.
  
  
  RESULTS
  PubMed, Embase and Ovid Medline databases were searched for prospective studies published up until October 11th, 2013. Summary relative risks were estimated using a random effects model. Ten cohort studies with >5628 cases and 119,915 participants were included. The summary RR for high vs. low resting heart rate was 1.83 (95% CI: 1.28-2.60, I(2) = 88%, n = 7), and in the dose-response analysis the summary RR was 1.20 (95% CI: 1.07-1.34, I(2) = 93%, n = 9) for an increase of 10 beats per minute. The heterogeneity was to a large degree explained by two studies. There was evidence of nonlinear associations between resting heart rate (pnonlinearity < 0.0001) and risk of type 2 diabetes.
  
  
  CONCLUSIONS
  The current meta-analysis indicates a strong positive association between high resting heart rate and the risk of type 2 diabetes. As a non-invasive marker of type 2 diabetes risk, resting heart rate may have potential in the clinical setting, especially for interventions aimed at lowering the risk of type 2 diabetes. Additional studies are needed to clarify the mechanisms that may be responsible for the assoiation between resting heart rate and type 2 diabetes.
authors.affiliation: Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom. Electronic address: d.aune@imperial.ac.uk.
authors.forename: D
authors.initials: D
authors.lastname: Aune
authors.affiliation: Dalio Institute of Cardiovascular Imaging, Weill Cornell Medical College, New York, USA; Department of Internal Medicine/Section of Geriatrics, Yale School of Medicine, New Haven, USA.
authors.forename: B
authors.initials: B
authors.lastname: Ó Hartaigh
authors.affiliation: Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
authors.forename: L J
authors.initials: LJ
authors.lastname: Vatten
mesh_terms: D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D006339:Heart Rate; D006801:Humans; D017711:Nonlinear Dynamics; D011237:Predictive Value of Tests; D011379:Prognosis; D012146:Rest; D018570:Risk Assessment; D012307:Risk Factors
keywords: Meta-analysis; Resting heart rate; Systematic review; Type 2 diabetes