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STATE-OF-THE-ART PAPER

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

^_* Royal Brompton Hospital, London, England
Weill Medical College of Cornell University, New York, New York
Division of Cardiac and Vascular Sciences, St. George's University of London, London, England
Hôpital Européen Georges Pompidou, Paris, France
^|| Arcispedale S. Anna, Divisione di Cardiologia, University of Ferrara, Ferrara, Italy
^¶ Hospital Universitario La Paz, Madrid, Spain
^# Hôpital Bichat, Claude Bernard, Paris, France
^_** Montreal Heart Institute, Université de Montreal, Montreal, Canada
Department of Cardiology, Policlinico San Matteo, Institute of Care and Research, Pavia, Italy
Silesian School of Medicine, 3rd Division of Cardiology, Katowice, Poland

Manuscript received December 21, 2006; revised manuscript received March 27, 2007, accepted April 10, 2007.

^_* Reprint requests and correspondence: Dr. Kim Fox, Royal Brompton Hospital, Sydney Street, London SW3 6NP, England. (Email: k.fox{at}rbh.nthames.nhs.uk).

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.

Abbreviations and Acronyms   AMI = acute myocardial infarction   HR = heart rate

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