Resting heart rate and the risk of death and cardiovascular complications in patients with type 2 diabetes mellitus

G. S. Hillis, M. Woodward, A. Rodgers, C. K. Chow, Q. Li, S. Zoungas, A. Patel, R. Webster, G. D. Batty, T. Ninomiya, G. Mancia, N. R. Poulte, J. Chalmers

Research output: Contribution to journalArticlepeer-review

63 Scopus citations


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], p00.001).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.

Original languageEnglish (US)
Pages (from-to)1283-1290
Number of pages8
Issue number5
StatePublished - May 2012
Externally publishedYes


  • Heart rate
  • Outcome
  • Type 2 diabetes mellitus

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism


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