Risk factors for longitudinal resting heart rate and its associations with cardiovascular outcomes in the DCCT/EDIC study

Sareh Keshavarzi, Barbara H. Braffett, Rodica Pop-Busui, Trevor J. Orchard, Elsayed Z. Soliman, Gayle M. Lorenzi, Annette Barnie, Amy B. Karger, Rose A. Gubitosi-Klug, Samuel Dagogo-Jack, Andrew D. Paterson

Research output: Contribution to journalArticlepeer-review

Abstract

OBJECTIVE Individuals with diabetes have higher resting heart rate compared with those without, which may be predictive of long-term cardiovascular disease (CVD) risk. Using data from the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and ComplicationsDCCT/EDIC)(study, we evaluated whether the beneficial effect ofintensive versus conventional diabetestherapy on heart rate persisted, the factors mediating the differences in heart rate between treatment groups, and the effects of heart rate on future CVD risk. RESEARCH DESIGN AND METHODS Longitudinal changes in heart rate, from annual electrocardiograms over 22 years of EDIC follow-up, were evaluated in 1,402 participants with type 1 diabetes. Linear mixed models were used to assess the effect of DCCT treatment group on mean heart rate over time, and Cox proportional hazards models were used to estimate the effect of heart rate on CVD risk during DCCT/EDIC. RESULTS At DCCT closeout, 52% of participants were male and mean 6 SD age was 33 6 7 years, diabetes duration 12 6 5 years, and HbA1c 7.4 6 1.2% (intensive) and 9.1 6 1.6% (conventional). Through EDIC, participants in the intensive group had significantly lower heart rate in comparison with the conventional group. While significant group differences in heart rate were fully attenuated by DCCT/EDIC mean HbA1c, higher heart rate predicted CVD and major adverse cardiovascular events independent of other risk factors. CONCLUSIONS After 22 years of follow-up, former intensive versus conventional therapy remained significantly associated with lower heart rate, consistent with the long-term beneficial effects of intensive therapy on CVD. DCCT treatment group effects on heart rate were explained by differences in DCCT/EDIC mean HbA1c.

Original languageEnglish (US)
Pages (from-to)1125-1132
Number of pages8
JournalDiabetes care
Volume44
Issue number5
DOIs
StatePublished - May 1 2021

Bibliographical note

Funding Information:
DCCT/EDIC has been supported by cooperative agreement grants (1982?1993, 2012?2017, 2017?2022) and contracts (1982?2012) with the Division of Diabetes, Endocrinology, and Metabolic Diseases of the National Institute of Diabetes and Digestive and Kidney Diseases (current grant numbers U01 DK094176 and U01 DK094157) and through support by the National Eye Institute, the National Institute of Neurological Disorders and Stroke, the General Clinical Research Centers Program (1993?2007), and Clinical Translational Science Center Program (2006?present), Bethesda, MD. Industry contributors have provided free or discounted supplies or equipment to support participants? adherence to the study: Abbott Diabetes Care (Alameda, CA), Animas (Westchester, PA), Bayer Diabetes Care (North America Headquarters, Tarrytown, NY), Becton Dickinson (Franklin Lakes, NJ), Eli Lilly (Indianapolis, IN), Extend Nutrition (St. Louis, MO), Insulet Corporation (Bedford,MA), Lifescan (Milpitas,CA), Medtronic Diabetes (Minneapolis, MN), Nipro Home Diagnostics (Fort Lauderdale, FL), Nova Diabetes Care (Billerica, MA), Omron (Shelton, CT), Perrigo Diabetes Care (Allegan, MI), Roche Diabetes Care (Indianapolis, IN), and Sanofi (Bridgewater, NJ).

Funding Information:
Funding. DCCT/EDIC has been supported by co-operative agreement grants (1982–1993, 2012–2017, 2017–2022) and contracts (1982–2012) with the Division of Diabetes, Endocrinology, and Metabolic Diseases of the National Institute of Diabetes and Digestive and Kidney Diseases (current grant numbers U01 DK094176 and U01 DK094157) and through support by the National Eye Institute, the National Institute of Neurological Disorders and Stroke, the General Clinical Research Centers Program (1993–2007), and Clinical Translational Science Center Program (2006–present), Bethesda, MD. Industry contributors have provided free or discounted supplies or equipment to support participants’ adherence to the study: Abbott Diabetes Care (Alameda, CA), Animas (Westchester, PA), Bayer Diabetes Care (North America Headquarters, Tarrytown, NY), Becton Dickinson (Franklin Lakes, NJ), Eli Lilly (Indianapolis, IN), Extend Nutrition (St. Louis, MO), Insulet Corporation (Bedford,MA),Lifescan(Milpitas,CA),Medtronic Diabetes (Minneapolis, MN), Nipro Home Diagnostics (Fort Lauderdale, FL), Nova Diabetes Care (Billerica, MA), Omron (Shelton, CT), Perrigo Diabetes Care (Allegan, MI), Roche Diabetes Care (Indianapolis, IN), and Sanofi (Bridgewater, NJ).

Publisher Copyright:
© 2021 by the American Diabetes Association.

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural

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