Abnormal HR Shifts Tied to Risk for Death in Diabetes

TOPLINE: MADRID — Impaired circadian heart rate (HR) fluctuations are linked to increased cardiovascular and all-cause mortality in patients with long-standing diabetes. METHODOLOGY: Researchers analyzed data from 349 patients with type 2 (81%) or type 1 diabetes in the CHAMPION cohort; about half were women, with a mean age of 57 years, body mass index

TOPLINE:

MADRID — Impaired circadian heart rate (HR) fluctuations are linked to increased cardiovascular and all-cause mortality in patients with long-standing diabetes.

METHODOLOGY:

Researchers analyzed data from 349 patients with type 2 (81%) or type 1 diabetes in the CHAMPION cohort; about half were women, with a mean age of 57 years, body mass index (BMI) of 29.4, and A1c of 8.6%.
Participants underwent 24-hour ambulatory blood pressure monitoring (APBM) and HR monitoring, as well as assessment of diabetic microvascular complications.
The median SD value of ABPM-derived HR measurements was used to define patients with low daily HR fluctuations (low 24h-HR SD); a <1src% decline in average nighttime vs daytime HR identified patients (31%) with a blunted nocturnal HR dip.

TAKEAWAY:

Low 24h-HR SD and blunted nocturnal HR dip were associated with an adverse cardiometabolic risk profile and a high prevalence of cardiac autonomic neuropathy and nephropathy.
After a mean 21 years of follow-up, 136 (39%) deaths occurred, of which 1srcsrc (68%) had a cardiovascular cause.
After adjustment for potential confounders — including age, sex, BMI, glycemic control, diabetes type, and hypertension — the low 24h-HR SD group had double the risk (hazard ratio [HR], 1.99) for cardiovascular mortality and a 5src% higher risk (HR, 1.5src) for all-cause mortality than the high 24h-HR SD group.
Patients with a blunted nocturnal HR dip consistently had a 39% higher adjusted risk for cardiovascular and all-cause mortality (HR, 1.61 for both) than those with a preserved nocturnal HR dip.

IN PRACTICE:

Impaired circadian HR fluctuations are associated with microvascular disease and increased long-term cardiovascular and all-cause mortality in patients with diabetes, the authors wrote. “Identifying these conditions via 24h-ABPM may provide a cost-effective risk stratification tool in this high-risk population.”