Association of Fasting Plasma Glucose With Heart Rate Recovery in Healthy Adults
A Population-Based Study
- 1Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
- 2Department of Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio
- 3Department of Cardiothoracic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
- 4Department of Biostatistics and Epidemiology, Cleveland Clinic Foundation, Cleveland, Ohio
- 5Department of Endocrinology, Cleveland Clinic Foundation, Cleveland, Ohio
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.
Footnotes
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Address correspondence and reprint requests to Michael S. Lauer, MD, FACC, Director of Clinical Research and Stress Laboratory, Department of Cardiology, Desk F-25, Cleveland Clinic Foundation, Cleveland, OH 44195. E-mail lauerm{at}ccf.org.
Received for publication 2 July 2001 and accepted in revised form 19 November 2001.
This article uses data supplied by the National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services. The views expressed in this article are those of the authors and do not necessarily reflect the views of the National Heart, Lung, and Blood Institute.
1Formula in SI Units was derived from the original model in which a decrease of (500/glucose) by one corresponded to an increase in plasma glucose of ∼25 mg/dl at a level of 100 mg/dl.
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