Resting heart rate and the risk of death and cardiovascular complications in patients with type 2 diabetes mellitus
Open accessAbstract
Aims/hypothesis 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/interpretation 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.
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Resting heart rate is a prognostic marker of cardiovascular morbidity and mortality and has been linked to insulin resistance and diabetes-related complications.
“RHR is a prognostic marker of cardiovascular morbidity and mortality and has been linked to insulin resistance and diabetes-related complications (8).”
From Obstructive Sleep Apnea, Resting Heart Rate, and Glycemic Variability in Adults With Maturity-Onset Diabetes of the Young (2026) · cites this paper as [8]
The Discussion reports that higher resting heart rate predicts all-cause mortality, cardiovascular death, and major cardiovascular events in patients with type 2 diabetes. The Potential mechanisms section links heart rate to elevated insulin levels and to diabetic autonomic neuropathy, but it does not establish a link specifically to insulin resistance. (LLM, conf=0.88)
Experimental — accuracy not yet measuredMicro- or macroalbuminuria, estimated GFR, heart rate, and white blood cell count have been shown in recent studies to be potentially predictive of diabetic complications.
“We also included risk factors shown in recent studies to be potentially predictive of diabetic complications: micro- or macroalbuminuria [11], estimated GFR (eGFR) [12], heart rate [13] and white blood cell count [14].”
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- Authors
- Hillis, G. S., Woodward, M., Rodgers, A., Chow, C. K., Li, Q., Zoungas, S., Patel, A., Webster, R., Batty, G. D., Ninomiya, T., Mancia, G., Poulter, N. R., & Chalmers, J.
- Affiliations
- Royal Prince Alfred Hospital (AU)
- University College London (GB)
- Kyushu University (JP)
- University of Milano-Bicocca (IT)
- Imperial College London (GB)
- Corresponding author
- Hillis, G. S.
- ORCID
- Venue
- Diabetologia
- Published
- 2012-01-29
- Volume
- 55
- Issue
- 5
- Pages
- 1283-1290
- ISSN
- 0012-186X (ISSN-L)
- 1432-0428
- PMC
- PMC4170780
- OpenAlex
- W2153546653
- Cited by
- 117
- References
- 43
- Citations by year
- 2026: 2 · 2025: 11 · 2024: 9 · 2023: 12 · 2022: 3 · 2021: 11 · 2020: 9 · 2019: 13 · 2018: 8 · 2017: 7 · 2016: 11 · 2015: 5 · 2014: 7 · 2013: 5 · 2012: 4
- FWCI
- 4.32
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Diabetologia (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- UWA Profiles and Research Repository (UWA) (submittedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Funders
- Wellcome Trust (081021)
- Servier
- Medical Research Council
- National Health and Medical Research Council (211086, 358395)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart rate and cardiovascular health
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Keywords
- resting heart rate, type 2 diabetes, all-cause mortality, cardiovascular mortality, cardiovascular complications, myocardial infarction, stroke, macrovascular complications, ADVANCE trial, cardiovascular risk markers
- MeSH terms
- Aged, Cardiovascular Diseases, Cause of Death, Diabetes Mellitus, Type 2, Diabetic Angiopathies, Female, Heart Rate, Humans, Male, Middle Aged, Myocardial Infarction, Risk, Stroke, Microvessels, Diabetic Cardiomyopathies
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