The association of resting heart rate and mortality by gender in a rural adult Chinese population: a cohort study with a 6-year follow-up

Sex-specific association of resting heart rate with type 2 diabetes mellitus

AIM

This study aimed to explore the association of resting heart rate (RHR) with type 2 diabetes mellitus (T2DM) by sex, and whether the association was mediated by insulin resistance (IR).

METHODS

This cross-sectional study enrolled 12,508 participants (median age 57 years), with information collection through questionnaire interview, anthropometric and laboratory measurements. Multivariable logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) of the association between RHR and T2DM by sex, and restricted cubic splines were used to describe the dose-response association. Mediation analysis was used to explore the contribution of IR, measured by homeostasis model assessment of insulin resistance (HOMA-IR) index, to RHR-related T2DM.

RESULTS

Among 12,508 participants, 1413 participants (11.30%) had T2DM. RHR was positively associated with T2DM (per 10-bpm increase in RHR, OR 1.48, 95% CI: 1.34-1.64 for men and OR 1.42, 95% CI: 1.32-1.52 for women). As compared with RHR = 75 bpm, with increasing RHR, the adjusted probability of T2DM was significantly increased for both men and women. HOMA-IR partially mediated the association (indirect effect: OR = 1.17, 95% CI:1.13-1.22; direct effect: OR = 1.25, 95% CI: 1.11-1.39 in men and indirect effect: OR = 1.16, 95% CI:1.13-1.20; direct effect: OR = 1.15, 95% CI: 1.15-1.35 in women).

CONCLUSION

RHR was significantly associated with T2DM, which suggests that RHR may be a non-invasive clinical marker of early intervention to prevent T2DM, and IR may partially mediated RHR-related T2DM.

Sex-Specific Association of Blood Pressure Categories With All-Cause Mortality: The Rural Chinese Cohort Study

Introduction

The relationship between blood pressure categories and all-cause mortality has not been fully addressed in cohort studies, especially in the general Chinese population. Our study aimed to assess the sex-specific association of systolic blood pressure (SBP), diastolic blood pressure (DBP), and 2017 United States hypertension guidelines with all-cause mortality in China.

Methods

We conducted a prospective study of 13,760 rural Chinese adults aged 18 or older (41.1% men). Mean age overall was 49.4, 51.0 for men, and 48.3 for women. We analyzed the blood pressure–mortality relationship by using restricted cubic splines and Cox proportional-hazards regression analysis, estimating hazard ratios (HRs) and 95% confidence intervals (CIs).

Results

During a mean follow-up of 5.95 years, 710 people died (60.3% men) from any cause. We found a U-shaped SBP–mortality or DBP–mortality relationship for both sexes. Mortality risk was increased for men with SBP 120–139 mm Hg (adjusted HR [aHR], 1.42; 95% CI, 1.10–1.82) or ≥140 mm Hg (aHR, 2.05; 95% CI, 1.54–2.72), and for DBP ≥90 mm Hg (aHR, 1.53; 95% CI, 1.10–2.13) as compared with SBP 100–119 mm Hg or DBP 70–79 mm Hg. Mortality risk also was increased for men with blood pressure status defined according to 2017 US hypertension guidelines as elevated, SBP 120–129 and DBP >80 mm Hg (aHR 1.48; 95% CI,1.11–1.98); stage 1 hypertension, SBP/DBP 130–139/80–89 mm Hg (aHR 1.53; CI, 1.19–1.97); and stage 2 hypertension, SBP/DBP ≥140/90 mm Hg (aHR 1.83; CI, 1.33–2.51). No significant relationship was observed for women.

Conclusion

Elevated blood pressure and stages 1 and 2 hypertension were positively associated with all-cause mortality for men but not women in rural China.