Resting Heart Rate in Cardiovascular Disease

Kim Fox, MD, FESC,* Jeffrey S. Borer, MD, FACC,† A. John Camm, MD, FESC, FACC,‡ Nicolas Danchin, MD, FESC,§ Roberto Ferrari, MD, FESC,􏰀
Jose L. Lopez Sendon, MD, FESC, FACC,¶ Philippe Gabriel Steg, MD, FESC, FACC,# Jean-Claude Tardif, MD, FACC, FRCPC,** Luigi Tavazzi, MD, FESC, FACC,†† Michal Tendera, MD, FESC, FACC,‡‡ for the Heart Rate Working Group

London, England; New York, New York; Paris, France; Ferrara and Pavia, Italy; Madrid, Spain; Montreal, Canada; and Katowice, Poland
Journal of the American College of Cardiology
© 2007 by the American College of Cardiology Foundation Published by Elsevier Inc.

Vol. 50, No. 9, 2007 ISSN 0735-1097/07/$32.00 doi:10.1016/j.jacc.2007.04.079


“The importance of resting heart rate (HR) as a prognostic factor and potential therapeutic target is not yet generally accepted. Recent large epidemiologic studies have confirmed earlier studies that showed resting HR to be an independent predictor of cardiovascular and all-cause mortality in men and women with and without diagnosed cardiovascular disease. Clinical trial data suggest that HR reduction itself is an important mechanism of benefit of beta-blockers and other heart-rate lowering drugs used after acute myocardial infarction, in chronic heart failure, and in stable angina pectoris. Pathophysiological studies indicate that a relatively high HR has di- rect detrimental effects on the progression of coronary atherosclerosis, on the occurrence of myocardial ischemia and ventricular arrhythmias, and on left ventricular function. Studies have found a continuous increase in risk with HR above 60 beats/min. Although it may be difficult to define an optimal HR for a given individual, it seems desirable to maintain resting HR substantially below the traditionally defined tachycardia threshold of 90 or 100 beats/min. These findings suggest that the potential role of HR and its modulation should be considered in future cardiovascular guidance documents…


“Current data leave little doubt that HR is a risk factor for cardiovascular mortality, independent of currently accepted risk factors and other potentially confounding demographic and physiological characteristics. However, until now it has been difficult to determine whether modulation of HR can beneficially alter risk; currently available interventions that lower HR, such as beta-blockers, certain calcium channel blockers, and physical conditioning have multiple additional actions. Nonetheless, the data we have presented suggest that improved understanding of the relationship between HR, its modification, and cardiovascular health is important and potentially beneficial for patient care. To realize this benefit, awareness of the potential importance of HR must be enhanced. Currently, HR is not recognized as a factor for cardiovascular risk assessment or risk reduction in U.S. and European guidelines (14,73,74). Emerging data presented herein suggest that the potential role of HR and its modulation should be seriously considered in future cardiovascular guidance documents


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