Lack of prognostic value of resting heart rate on cardiovascular and renal outcomes in T2DM patients
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| Rok publikování | 2013 |
| Druh | Konferenční abstrakty |
| Citace | |
| Popis | Background and aims: Elevated resting heart rate (RHR) has been associated with increased risk of mortality and cardiovascular (CV) events in healthy subjects as well as those with pre-existing CV disease (CVD). Limited data are available on the RHR effect on CV and renal morbidity and mortality in type 2 diabetic (T2DM) subjects. Aims of our study was to study and eventually replicate previous sporadic positive findings on whether RHR can be considered as a simple and reliable predictor of serious disease outcomes such as CV and renal disease progression and death in T2DM patients. Materials and methods: A total of 300 T2DM patients (50percent of men, age 67 [IQR 60 – 75], median DM duration 13 years [IQR 8 – 20]) with variable stage of diabetic kidney disease (DKD) at baseline were prospectively followed for a median of 38 [21 – 65] months. RHR at baseline was determined either by 1 minute radial artery palpation or from ECG records. Following end-points were considered: (1) progression of DKD, i.e. decline of GFR above 60ml/min during the follow-up period for those with GFR under 60 at baseline or progression of CKD by at least stage for those with GFR under 60ml/min at baseline or development of overt proteinuria in normo- and microalbuminuric subjects at baseline, (2) CV event (fatal or non-fatal myocardial infarction or stroke, lower limb arterial disease with claudication or amputation) and (3) all-cause mortality. A history of the CVD was present in 209 (70percent) patients at baseline, DKD (GFR above 60ml/min or proteinuria was present in 244 (81percent) at baseline. Time-to-event analysis (Kaplan-Meier) was used to analyze the effect of RHR categories (under and above actual median RHR and arbitrary cut-off 70bpm) on studied outcomes. Results: Cumulative incidence of DKD progression, CV event and all-cause mortality were 41, 19 and 23percent, respectively, in the whole group. Median RHR was 74 bpm. Although RHR was not significantly higher in subjects with CVD or DKD at baseline (b+) (P above 0.05 in both groups, Mann-Whitney), analyses were still performed for both (i) whole group and (ii) CVD-b+ and (iii) DKD-b+ subgroups. Using time-to-event analyses significant differences in the cumulative incidence of the three studied outcomes between RHR under/above70 or 74bpm were found neither in the whole group nor in the CVD-b+ or DKD-b+ subgroups (P above 0.05, log-rank test). Conclusion: Unlike recent study in T2DM (Miot A et sl., Diabetes Care 2012) we have not been able to replicate any predictive effect of the RHR for the renal or CV outcomes in type 2 diabetic population of Czech Republic. Given similar settings of our study one of the possible explanations might be smaller sample size and slightly shorter follow-up. Additional studies are therefore required for the definitive conclusions regarding RHR, otherwise smart, cheap and widely applicable risk marker. Acknowledgement: Supported by grants NT11405 from The Ministry of Health of Czech Republic |
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