Diabetes Metab J.  2024 Jul;48(4):752-762. 10.4093/dmj.2023.0305.

Temporal Changes in Resting Heart Rate and Risk of Diabetes Mellitus

• Son MK
• Lee K
• Park HY

• KMID: 2558042
• DOI: http://doi.org/10.4093/dmj.2023.0305

Abstract

Background
To investigate the association between the time-varying resting heart rate (RHR) and change in RHR (∆RHR) over time and the risk of diabetes mellitus (DM) by sex.
Methods
We assessed 8,392 participants without DM or atrial fibrillation/flutter from the Korean Genome and Epidemiology Study, a community-based prospective cohort study that was initiated in 2001 to 2002. The participants were followed up until December 31, 2018. Updating RHR with biennial in-study re-examinations, the time-varying ∆RHR was calculated by assessing the ∆RHR at the next follow-up visit.
Results
Over a median follow-up of 12.3 years, 1,345 participants (16.2%) had DM. As compared with RHR of 60 to 69 bpm, for RHR of ≥80 bpm, the incidence of DM was significantly increased for both male and female. A drop of ≥5 bpm in ∆RHR when compared with the stable ∆RHR group (–5< ∆RHR <5 bpm) was associated significantly with lower risk of DM in both male and female. However, an increase of ≥5 bpm in ∆RHR was significantly associated with higher risk of DM only in female, not in male (hazard ratio for male, 1.057 [95% confidence interval, 0.869 to 1.285]; and for female, 1.218 [95% confidence interval, 1.008 to 1.471]).
Conclusion
In this community-based longitudinal cohort study, a reduction in ∆RHR was associated with a decreased risk of DM, while an increase in ∆RHR was associated with an increased risk of DM only in female.

Keyword

Diabetes mellitus; Heart rate; Longitudinal studies; Sex

Figure

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  Fig. 1. Trajectories of resting heart rate (RHR) before incident diabetes mellitus (DM) or last examination. Fitted lines denote mean RHR (incident DM vs. without incident DM), calculated from restricted cubic spline of mixed-effects linear regression models. Time 0=diagnosis or last examination. The dashed lines delimit the 95% confidence interval. (A) Time-varying RHR and DM in male. (B) Time-varying RHR and DM in female. (C) Time-varying change in RHR (∆RHR) and DM in male. (D) Time-varying ∆RHR and DM in female.

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  Fig. 2. Subgroup analysis for the risk of diabetes mellitus according to the resting heart rate (RHR). Adjusted for sex, area, and time-updated age, body mass index (BMI), physical activity, smoking, drinking, systolic blood pressure, antihypertensive drug use, chronic kidney disease, cardiovascular disease (CVD), glycosylated hemoglobin, total cholesterol, and change in RHR. HR, hazard ratio; CI, confidence interval.

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  Fig. 3. Subgroup analysis for the risk of diabetes mellitus according to the change in resting heart rate (∆RHR). Adjusted for sex, area, and time-updated age, body mass index (BMI), physical activity, smoking, drinking, systolic blood pressure, antihypertensive drug use, chronic kidney disease, cardiovascular disease (CVD), glycosylated hemoglobin, total cholesterol, and RHR. HR, hazard ratio; CI, confidence interval.

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  Fig. 4. Association between resting heart rate (RHR) and the incidence of diabetes mellitus (DM). The adjusted cubic spline model demonstrates the flexible association between time-varying RHR, including all available RHR values before an event or end of the study, and the hazard of DM incidence overall (A), in male (B), and in female (C) with 60 bpm taken as the reference RHR. The adjusted cubic spline model demonstrates the flexible association between time-varying change in RHR (∆RHR) from the follow-up visit and the hazard of DM incidence overall (D) when a RHR change of 0 bpm is taken as the reference. The dashed black curves represent the upper and lower 95% confidence limits. The horizontal red line represents the hazard ratio (HR) of 1.

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