Association of Fasting Plasma Glucose With Heart Rate Recovery in Healthy Adults

Abstract

Diabetes is associated with abnormal autonomic function and increased mortality. Abnormal heart rate recovery after exercise, a measure of autonomic dysfunction, is also associated with increased mortality. The objective of this study was to determine the association of fasting plasma glucose with abnormal heart rate recovery and its prognostic importance in healthy adults. We studied 5,190 healthy adults who did not have medically treated diabetes (mean age 45 years, 39% women), were enrolled in the Lipid Research Clinics' Prevalence Study, and underwent exercise testing. Heart rate recovery was defined as the change from peak heart rate to that after 2 min of recovery; an abnormal value was <42 bpm. All-cause mortality was assessed over 12 years. A total of 504 participants (10%) had impaired fasting glucose, and 131 (3%) had untreated diabetes. An abnormal heart rate recovery was found in 1,699 (33%). Compared with participants who had normal fasting plasma glucose, abnormal heart rate recovery was more common among those with impaired fasting glucose (42 vs. 31%; relative risk, 1.34; 95% confidence interval [CI], 1.20 -1.50; P < 0.0001) and those with diabetes (50 vs. 31%; relative risk, 1.61; 95% CI, 1.35-1.92; P < 0.0001). Fasting plasma glucose remained an independent predictor of abnormal heart rate recovery even after adjustment for age, sex, and other confounders (P ‫؍‬ 0.0003). An abnormal heart rate recovery added to impaired fasting plasma glucose for the prediction of death. Fasting plasma glucose is strongly and independently associated with abnormal heart rate recovery, even at nondiabetic levels. Diabetes 51:803-807, 2002 D iabetes and impaired fasting glucose are associated with increased mortality, particularly from cardiovascular causes (1-3). Diabetes is frequently complicated by an autonomic neuropathy (4), which can be detected by noting reduced heart rate variability (5,6). The Framingham Heart Study demonstrated a reduction of heart rate variability, along with a sympathetic-parasympathetic imbalance, not only in patients with diabetes but also in individuals with impaired fasting glucose (7).Abnormal heart rate recovery after exercise is an easyto-measure marker of reduced parasympathetic activity (8,9) and has been found to be an independent predictor of mortality in submaximal as well as in symptom-limited exercise stress testing (10 -12). Given the known associations among diabetes, impaired fasting glucose, and autonomic dysfunction, we hypothesized that increasing levels of fasting glucose would be associated with higher rates of abnormal heart rate recovery and that this association would be of prognostic importance. We tested these hypotheses in a healthy, population-based cohort of adults who did not have medically treated diabetes. RESEARCH DESIGN AND METHODSPopulation sample. The study population, derived from the Lipid Research Clinics Prevalence Study, a cross-sectional survey among North Americans assembled to determine the prevalence of dyslipidemia and its association wit...

Increased prevalence of cardiac autonomic dysfunction at different degrees of glucose intolerance in the general population: the KORA S4 survey

“…While some studies have demonstrated reduced measures of HRVor heart rate in persons with IFG compared with those with NFG [8][9][10], others showed no such differences [11][12][13][14][15]. Moreover, these studies did not evaluate the complete spectrum of glucose intolerance, i.e.…”

“…Nine population-based studies assessing the relationship between HRV and glucose intolerance have been published [8][9][10][11][12][13][14][15][16]. While some studies have demonstrated reduced measures of HRVor heart rate in persons with IFG compared with those with NFG [8][9][10], others showed no such differences [11][12][13][14][15].…”

“…However, whether impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) are associated with a higher risk of cardiovascular autonomic neuropathy (CAN) is a matter of ongoing debate [5][6][7]. A limited number of studies have reported contradictory data on whether reduced heart rate variability (HRV) may be more frequently encountered in persons with IFG and IGT than in those with normal glucose tolerance (NGT) or normal fasting glucose (NFG) in representative populations [8][9][10][11][12][13][14][15][16]. Several relatively small clinic-based studies which were not representative for the general population were also published [17][18][19][20][21][22][23].…”

Inverse Correlation Between Heart Rate Recovery and Metabolic Risks in Healthy Children and Adolescents

“…Slower HRR following exercise has been linked to the metabolic syndrome and several of its components in young adults (6,7) and elderly people (8). Since the presence of metabolic syndrome conveys an increased risk of metabolic disease and operates early in children and adolescents (9,10), it is possible that the adverse effects of the metabolic components on HRR might function in young ages.…”

ATraditional Risk Factors as Determinants of Heart Rate Recovery in Patients with Diabetes Mellitus type 2 Without Known Coronary Artery Disease

“…It is a new index clinically significant in evaluating the cardiac autonomic system, especially the parasympathetic nervous function after exercise. Panzer et al reported that abnormal HRR was present among 42% of patients with impaired fasting glucose and 50% with diabetes 8 . HRR is considered as a strong predictor of increased cardiovascular disease and overall mortality, independently of other cardiac risk factors 9 .Several studies have also shown that abnormal HRR is a predictor of poor prognosis in patients with heart failure 10,11 .…”