Resting Heart Rate and Outcomes in Patients with Cardiovascular Disease: Where Do We Currently Stand?

Abstract

BackgroundData from large epidemiological studies suggest that elevated heart rate is independently associated with cardiovascular and all-cause mortality in patients with hypertension and in those with established cardiovascular disease. Clinical trial findings also suggest that the favorable effects of beta-blockers and other heart rate–lowering agents in patients with acute myocardial infarction and congestive heart failure may be, at least in part, due to their heart rate–lowering effects. Contemporary clinical outcome prediction models such as the Global Registry of Acute Coronary Events (GRACE) score include admission heart rate as an independent risk factor.AimsThis article critically reviews the key epidemiology concerning heart rate and cardiovascular risk, potential mechanisms through which an elevated resting heart rate may be disadvantageous and evaluates clinical trial outcomes associated with pharmacological reduction in resting heart rate.ConclusionsProspective randomised data from patients with significant coronary heart disease or heart failure suggest that intervention to reduce heart rate in those with a resting heart rate >70 bpm may reduce cardiovascular risk. Given the established observational data and randomised trial evidence, it now appears appropriate to include reduction of elevated resting heart rate by lifestyle +/− pharmacological therapy as part of a secondary prevention strategy in patients with cardiovascular disease.

ApoA1 and ApoA1-specific self-antibodies in cardiovascular disease

“…102 RHR serves as an established prognostic indicator of CVD progression after MI. 103,104 In cultured rat cardiomyocytes treated with aldosterone and ApoA1 antibodies, contraction rate was found to progressively correlate with titers of ApoA1 antibodies in a dose-dependent manner. 102 The positive Figure 1 ApoA1-specific self-antibodies and their functional effects in cardiovascular pathophysiology (a-c).…”

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“…[8][9][10]21 The reduction is dose dependent and the maximal effect is achieved after 2-4 weeks of therapy. 22 At the end of our study, the percent decrease from baseline HR was significantly higher in the ivabradine group when compared to control.…”

“…2 The anti-anginal and anti-ischemic efficacy of ivabradine-in monotherapy or in combination with a β-blocker-has been demonstrated by several clinical trials. [8][9][10] As a consequence, the substance evolved as an alternative strategy particularly for patients in whom the use of β-blockers is contraindicated, intolerable or patients who remain symptomatic despite β -blockade.…”

Clinical Usefulness of Serum Uric Acid and Resting Heart Rate in the Diagnosis of Metabolic Syndrome in Korean Adults

“…안정시 심박수(resting heart rate)는 1분 동안 심장이 수축 하여 혈액을 온몸으로 박출하는 횟수를 의미하며 (Diaz et al, 2005), 굴심방결절 활동에 의해 결정되고 교감신경과 미주신경활성의 상호작용에 의해 영향을 받는다 (Menown et al, 2013). 안정시 심박수 증가는 교감신경의 과활성과 미주신경 긴장도(vagal tone) 감소를 나타내는 징후이며 (Nanchen et al, 2013), 자율신경계 이상을 파악할 수 있는 중요한 지표이다 (Palatini and Julius, 2004;Bemelmans et al, 2012;Johansen et al, 2013;Menown et al, 2013).…”

“…안정시 심박수 증가는 교감신경의 과활성과 미주신경 긴장도(vagal tone) 감소를 나타내는 징후이며 (Nanchen et al, 2013), 자율신경계 이상을 파악할 수 있는 중요한 지표이다 (Palatini and Julius, 2004;Bemelmans et al, 2012;Johansen et al, 2013;Menown et al, 2013). 교감신경 활성 증가에 따른 안정시 심박수 증가는 인슐린저항성과 비만에 선행하여 나타날 수 있으며, 교감신경 활성화는 인 슐린저항성의 원인이자 결과로 보고된다 (Bemelmans et al, 2012;Nanchen et al, 2013).…”