Author + information
- Received December 21, 2006
- Revision received March 27, 2007
- Accepted April 10, 2007
- Published online August 28, 2007.
- 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‡‡,
- Heart Rate Working Group
- ↵⁎Reprint requests and correspondence:
Dr. Kim Fox, Royal Brompton Hospital, Sydney Street, London SW3 6NP, England.
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 direct 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.
All authors have received honoraria and many have received research grants from Servier Laboratories, and all authors are a part of the advisory board of ivabradine, a sinus node inhibiting agent for the management of angina. However, this article is entirely about the importance of heart rate and does not discuss ivabradine at all. None of the authors have received any financial support from Servier Laboratories for the preparation of this article.
- Received December 21, 2006.
- Revision received March 27, 2007.
- Accepted April 10, 2007.
- American College of Cardiology Foundation