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Heart Rate Recovery Following Maximal Exercise Testing as a Predictor of Cardiovascular Disease and All-Cause Mortality in Men With Diabetes

¹ Cooper Institute, Center for Epidemiological Research, Dallas, Texas
² Cleveland Clinic Foundation, Cleveland, Ohio
³ The Cooper Clinic, Dallas, Texas

Address correspondence and reprint requests to Yiling J. Cheng, MD, PhD, The Cooper Institute, Center for Epidemiological Research, 12330 Preston Rd., Dallas, TX 75230. E-mail: ycheng{at}cooperinst.org.

OBJECTIVE—Heart rate recovery (HRR) is an independent prognostic indicator for cardiovascular disease (CVD) and all-cause mortality in healthy men. We examined the association of HRR to CVD-related and all-cause mortality in men with diabetes.

RESEARCH DESIGN AND METHODS—In this cohort study we examined 2,333 men with documented diabetes (mean age 49.4 years) that had baseline 5-min HRR measurement following maximal exercise (heart rate_peak - heart rate_{5 min of recovery}) at The Cooper Clinic, Dallas, TX. We identified HRR quartiles as quartile 1 <55, quartile 2 55–66, quartile 3 67–75, and quartile 4 >75 bpm. Hazard ratios (HRs) for cardiovascular and all-cause death were adjusted for age, cardiorespiratory fitness, resting heart rate, fasting blood glucose, BMI, smoking habit, alcohol consumption, total cholesterol, triglyceride, and history of CVD at baseline.

RESULTS—During a median of 14.9 years follow-up, there were 142 deaths that were considered CVD related and 287 total deaths. Compared with men in the highest quartile of HRR, adjusted HRs in the first, second, and third quartiles were 2.0 (95% CI 1.1–3.8), 1.5 (0.8–2.7), and 1.5 (0.9–2.8), respectively, for cardiovascular death (P for trend < 0.001). Similarly, for all-cause death, adjusted HRs in the first, second, and third quartiles were 2.0 (1.3–3.2), 1.5 (1.0–2.3), and 1.5 (1.1–2.3) (P for trend < 0.001).

CONCLUSIONS—Among men with diabetes, a decreased HRR, even measured as long as 5 min after recovery, was independently predictive of cardiovascular and all-cause death.

Abbreviations: ACLS, Aerobics Center Longitudinal Study • CVD, cardiovascular disease • ECG, electrocardiogram • HR, hazard ratio • HRR, heart rate recovery • MET, maximal metabolic equivalent

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