The Hospital for Sick Children, Toronto, Ontario, Canada.
The Biostatistics Center, Milken Institute School of Public Health, The George Washington University, Rockville, MD
Diabetes Care. 2021 May;44(5):1125-1132. doi: 10.2337/dc20-2387. Epub 2021 Feb 25.
Individuals with diabetes have higher resting heart rate compared with those without, which may be predictive of long-term cardiovascular disease (CVD) risk. Using data from the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study, we evaluated whether the beneficial effect of intensive versus conventional diabetes therapy on heart rate persisted, the factors mediating the differences in heart rate between treatment groups, and the effects of heart rate on future CVD risk.
Longitudinal changes in heart rate, from annual electrocardiograms over 22 years of EDIC follow-up, were evaluated in 1,402 participants with type 1 diabetes. Linear mixed models were used to assess the effect of DCCT treatment group on mean heart rate over time, and Cox proportional hazards models were used to estimate the effect of heart rate on CVD risk during DCCT/EDIC.
At DCCT closeout, 52% of participants were male and mean ± SD age was 33 ± 7 years, diabetes duration 12 ± 5 years, and HbA 7.4 ± 1.2% (intensive) and 9.1 ± 1.6% (conventional). Through EDIC, participants in the intensive group had significantly lower heart rate in comparison with the conventional group. While significant group differences in heart rate were fully attenuated by DCCT/EDIC mean HbA, higher heart rate predicted CVD and major adverse cardiovascular events independent of other risk factors.
After 22 years of follow-up, former intensive versus conventional therapy remained significantly associated with lower heart rate, consistent with the long-term beneficial effects of intensive therapy on CVD. DCCT treatment group effects on heart rate were explained by differences in DCCT/EDIC mean HbA.
与非糖尿病患者相比，糖尿病患者的静息心率更高，这可能预示着长期心血管疾病（CVD）风险。本研究利用糖尿病控制与并发症试验/糖尿病干预和并发症流行病学（DCCT/EDIC）研究的数据，评估强化与常规糖尿病治疗对心率的有益影响是否持续存在，以及治疗组之间心率差异的中介因素，以及心率对未来 CVD 风险的影响。
通过 EDIC 随访 22 年期间的年度心电图，评估了 1402 名 1 型糖尿病患者的心率纵向变化。线性混合模型用于评估 DCCT 治疗组对平均心率随时间的影响，Cox 比例风险模型用于估计心率对 DCCT/EDIC 期间 CVD 风险的影响。
在 DCCT 结束时，52%的参与者为男性，平均年龄±标准差为 33±7 岁，糖尿病病程为 12±5 年，HbA 分别为 7.4±1.2%（强化）和 9.1±1.6%（常规）。通过 EDIC，强化组的参与者心率明显低于常规组。虽然心率的显著组间差异完全被 DCCT/EDIC 平均 HbA 所削弱，但较高的心率独立于其他危险因素预测 CVD 和主要不良心血管事件。
在 22 年的随访后，与常规治疗相比，前强化治疗与较低的心率仍显著相关，这与强化治疗对 CVD 的长期有益影响一致。DCCT 治疗组对心率的影响可以用 DCCT/EDIC 平均 HbA 的差异来解释。
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