Minimum heart rate and coronary atherosclerosis: Independent relations to global severity and rate of progression of angiographic lesions in men with myocardial infarction at a young age

Perski, Aleksander; Olsson, Gunnar; Landou, Christian; Fairé, Ulf dé; Theorell, Töres; Hamsten, Anders

doi:10.1016/0002-8703(92)90497-j

Cited by 151 publications

(72 citation statements)

References 26 publications

(6 reference statements)

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“…29 It has also been suggested that severe arteriosclerosis is associated with elevated HR, with atherosclerotic thickening of the arterial tree the possible culprit in this phenomenon. 30,31 The beneficial effect of HR-lowering therapy (i.e., beta blockers) supports the findings of our study. Three doubleblind, randomized trials have compared beta blockers with placebo in UA.…”

Section: Pathophysiologic Mechanismssupporting

confidence: 89%

Does initial and delayed heart rate predict mortality in patients with acute coronary syndromes?

Kovar

Cannon

Bentley

et al. 2004

Clinical Cardiology

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Background: Lower admission heart rate (HR) is known to predict favorable outcome in ST‐elevation acute myocardial infarction. However, there are limited short‐term and no long‐term data available regarding the prediction value of the initial HR in patients with the full spectrum of acute coronary syndromes (ACS). In addition, it is unknown whether the HR obtained later during hospitalization for ACS (i.e., Day 2 or 3) remains prognostically valuable. Hypothesis: The aim of this study was to investigate the utility of the initial and delayed HR in predicting outcome in patients with ACS. Methods: We examined mortality at 30 days and 10 months in 10,267 patients with ACS enrolled in the oral glycoprotein IIb/IIIa inhibition with Orofiban in Patients with Unstable coronary Syndromes‐Thrombolysis In Myocardial Infarction (OPUS‐TIMI) 16 trial. Patients were stratified by HR and day from onset of ACS into the following groups: (1) HR < 60 beats/min, (2) HR 60‐80 beats/min, (3) HR 80‐100 beats/min, (4) HR > 100 beats/min; and HR obtained on (1) Day 1, (2) Day 2, and (3) Day 3. Results: By univariate analysis, mortality at 30 days and at 10 months increased progressively with higher HR strata (1.4 vs. 1.6 vs. 2.3 vs. 5.6%, p < 0.001, and 2.6 vs. 4.2 vs. 6.5 vs. 11.8%, p < 0.001, respectively). Elevated HR remained associated with mortality irrespective of time from onset of ACS. Conclusions: Higher initial and delayed HR is highly predictive of higher short‐ and long‐term mortality in patients with ACS. This is a simple marker that could be easily used in risk assessment.

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Section: Pathophysiologic Mechanismssupporting

confidence: 89%

Does initial and delayed heart rate predict mortality in patients with acute coronary syndromes?

Kovar

Cannon

Bentley

et al. 2004

Clinical Cardiology

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“…[1][2][3] Ambulatory ECG recordings have shown that the minimum HR measured during a 24-hour period is even more closely related to cardiac events than the casual HR or 24-hour average HR, 26 and blunted circadian rhythm of autonomic modulation of HR has been described in patients with coronary artery disease. 22 In this study, the elevated minimum HR during sleeping hours, but not the maximum HR, was found to be related to the progression of coronary artery stenoses, also providing a possible explanation for the prior epidemiological and clinical observations.…”

Section: Discussionmentioning

confidence: 99%

Heart Rate Variability and Progression of Coronary Atherosclerosis

Huikuri

Jokinen

Syvänne

et al. 1999

ATVB

251

144

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Abstract-Low heart rate (HR) variability is associated with increased risk of cardiovascular morbidity and mortality, but the causes and mechanisms of this association are not well known. This prospective study was designed to test the hypothesis that reduced HR variability is related to progression of coronary atherosclerosis. Average HR and HR variability were analyzed in 12-hour ambulatory ECG recordings from 265 qualified patients participating in a multicenter study to evaluate the angiographic progression of coronary artery disease in patients with prior coronary artery bypass surgery and low high-density lipoprotein cholesterol concentrations (Ͻ1.1 mmol/L). Participants were randomized to receive a placebo or gemfibrozil therapy. The progression of coronary atherosclerosis was estimated by quantitative, computer-assisted analysis of coronary artery stenoses from the baseline angiograms and from repeated angiograms performed an average of 32 months later. The progression of focal coronary atherosclerosis of the patients randomized to placebo therapy was more marked in the tertile with the lowest standard deviation of all normal to normal R-R intervals ( Key Words: coronary artery disease Ⅲ lipids Ⅲ heart period Ⅲ angiography E levated heart rate (HR) and reduced HR variability are associated with an increased risk of cardiovascular morbidity and mortality in various populations, 1-8 but the pathophysiological link between these associations is not well understood. Experimental studies on monkeys fed an atherogenic diet have demonstrated a relationship between resting HR and progression of coronary atherosclerosis, 9 -11 and there is also a strong relationship between HR and arterial stiffness, 12 but there has been little evidence of any association between HR, or its variability, and human coronary atherosclerosis.Progression of coronary artery stenoses in repeated coronary angiograms increases the risk of adverse cardiac events, suggesting that rapid progression predisposes patients to acute complications of coronary artery plaques and serves as a surrogate end point for clinical events. 13,14 Lipid-modifying therapy has been shown to prevent the progression of coronary atherosclerosis, confirming that abnormalities in plasma lipid concentrations are strongly associated with the progression of coronary artery disease and the occurrence of adverse clinical events. 14 However, lipid theory may not explain all aspects of coronary artery disease, eg, the rapid progression of discrete stenoses in specific coronary arterial regions, which is thought to result from an interplay of hemodynamic, metabolic, and hemostatic factors. [15][16][17][18] To test the hypothesis that elevated HR and reduced HR variability are associated with the progression of human coronary atherosclerosis in patients with lipid abnormalities, we studied HR and its variability, measured by ambulatory ECG, and the angiographic progression of coronary artery disease in patients with reduced HDL cholesterol concentrations.

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“…Thaulow and Erikssen reported that treatment with P-blockers reduces the frequency of silent ischemia in relation to the heart rate reduction produced (44). Perski et al observed that the minimum or average heart rate on 24-hour electrocardiographic monitoring was closely and independently related to the severity of coronary atherosclerosis in young post-infarction patients (45).…”

Section: Organ Involvementmentioning

confidence: 99%

Framingham Study Insights into Hypertensive Risk of Cardiovascular Disease.

1995

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Elevated blood pressure is a common and powerful predisposing factor for stroke, coronary disease, cardiac failure and peripheral artery disease imposing a 2-3 fold increased risk of one or more of these atherosclerotic sequelae. The risk ratio imposed by hypertension is greatest for cardiac failure and stroke, but in Western countries coronary disease is the most common and lethal hazard. In hypertensive men and women respectively, 35% and 45% of myocardial infarctions are silent or unrecognized necessitating routine periodic ECG examination for its detection. Comparison of the impacts of systolic and diastolic blood pressure gives no indication of a greater impact of diastolic pressure and isolated systolic hypertension is distinctly hazardous. Over-reliance on diastolic pressure to assess risk can be misleading, particularly in advanced age. Attributable risk estimates suggest that 78% of hypertension in men and 65% in women is directly attributable to adiposity, making weight control of paramount importance for primary prevention of hypertension. The likelihood of development of cardiovascular disease in the hypertensive patient is greatly enhanced by the presence of metabolically-linked risk factors and already existent cardiovascular conditions. These influence the urgency and choice of therapy. Rational and efficient assessment of the hypertensive candidate for cardiovascular disease requires use of a cardiovascular risk profile evaluating the joint effect of multiple risk factors and effective treatment improves multivariate risk. (Hypertens Res 1995; 18: 181-196)

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Minimum heart rate and coronary atherosclerosis: Independent relations to global severity and rate of progression of angiographic lesions in men with myocardial infarction at a young age

Cited by 151 publications

References 26 publications

Does initial and delayed heart rate predict mortality in patients with acute coronary syndromes?

Does initial and delayed heart rate predict mortality in patients with acute coronary syndromes?

Heart Rate Variability and Progression of Coronary Atherosclerosis

Framingham Study Insights into Hypertensive Risk of Cardiovascular Disease.

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