Document Detail

Heart rate as a treatable cardiovascular risk factor.
MedLine Citation:
PMID:  19474056     Owner:  NLM     Status:  MEDLINE    
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 I(f) 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 (>or=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.
Jean-Claude Tardif
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review     Date:  2009-05-27
Journal Detail:
Title:  British medical bulletin     Volume:  90     ISSN:  1471-8391     ISO Abbreviation:  Br. Med. Bull.     Publication Date:  2009  
Date Detail:
Created Date:  2009-06-02     Completed Date:  2009-10-01     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376542     Medline TA:  Br Med Bull     Country:  England    
Other Details:
Languages:  eng     Pagination:  71-84     Citation Subset:  IM    
Montreal Heart Institute, Montreal, QC, Canada H1T 1C8.
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MeSH Terms
Adrenergic beta-Antagonists / therapeutic use*
Antihypertensive Agents / therapeutic use*
Benzazepines / therapeutic use*
Coronary Disease / drug therapy*,  mortality
Evidence-Based Medicine
Heart Rate / drug effects*
Middle Aged
Practice Guidelines as Topic
Quality of Life
Risk Factors
Reg. No./Substance:
0/Adrenergic beta-Antagonists; 0/Antihypertensive Agents; 0/Benzazepines; 155974-00-8/ivabradine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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