Skip Navigation


British Medical Bulletin Advance Access originally published online on May 27, 2009
British Medical Bulletin 2009 90(1):71-84; doi:10.1093/bmb/ldp016
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow All Versions of this Article:
90/1/71    most recent
ldp016v1
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Related articles in BMB
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Tardif, J.-C.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Tardif, J.-C.
Related Collections
Right arrow Cardiovascular Disease
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

© The Author 2009. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org

Heart rate as a treatable cardiovascular risk factor

Jean-Claude Tardif*,{dagger},{ddagger}

{dagger} Montreal Heart Institute, Montreal, QC, Canada
{ddagger} Université de Montreal, Montreal, QC, Canada

* Correspondence to: Jean-Claude Tardif, Montreal Heart Institute, 5000 Belanger Street, Montreal, QC, Canada H1T 1C8. E-mail: jean-claude.tardif{at}icm-mhi.org

Background: Although several epidemiological studies demonstrate the association between resting heart rate (HR) and cardiovascular morbidity and mortality, an elevated HR remains a neglected cardiovascular risk factor.

Sources of data: This review summarizes the results of published studies on the relationship between elevated HR and cardiovascular risk.

Areas of agreement: The role of HR in myocardial ischaemia in coronary patients is well known. Experimental data and clinical observations support the importance of HR in the pathophysiology of atherosclerosis and plaque rupture. A large body of evidence points to high resting HR as a risk factor for mortality in various populations, including coronary patients.

Areas of controversy: HR reduction is suggested to be a mechanism explaining the prognostic benefit of beta-blockers after myocardial infarction or in heart failure patients. However, it was unclear whether HR reduction per se directly affects cardiovascular prognosis. Treatment with ivabradine, a pure HR-reducing agent, provides an opportunity to assess the effects of selectively lowering HR without altering other aspects of cardiac function.

Growing points: The results of the recent Morbidity–Mortality Evaluation of the If Inhibitor Ivabradine in Patients with Coronary Disease and Left Ventricular Dysfunction study underline the importance of HR reduction in the management of stable coronary artery disease. The prospective analysis of data from the placebo arm demonstrated that elevated resting HR (≥70 bpm) is a strong independent predictor of clinical outcomes. Consistent with these data, ivabradine significantly improved coronary outcomes in patients with a HR of 70 bpm or more.

Areas timely for development: These data support the importance of HR in the management of stable coronary artery disease to assess prognosis and to guide optimal therapy.

Keywords: heart rate • risk factors • cardiovascular disease • coronary artery disease

Accepted for publication April 21, 2009.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?

Related articles in BMB:

Editor's Choice
Norman Vetter
BMB 2009 90: 1-5. [Extract] [Full Text]  





Disclaimer: Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department.