Current status: Heart rate as a treatable risk factor

Abstract

Resting heart is an independent predictor of all-cause mortality and cardiovascular mortality. In patients with coronary artery disease and left ventricular dysfunction, the morBidity-mortality EvAlUaTion of the If inhibitor ivabradine in patients with coronary disease and left ventricULar dysfunction (BEAUTIFUL) trial showed that a heart rate of 70 b.p.m. or greater is an independent predictor of cardiovascular events. In patients with moderate-to-severe heart failure, the SHIFT (Systolic Heart failure treatment with the If inhibitor Trial) showed also that heart rate was a predictor of cardiovascular death and heart failure hospitalisation. Heart rate plays an important role in the pathophysiology of atherosclerosis. The BEAUTIFUL trial and SHIFT provide evidence for the benefits of heart rate reduction using the new heart rate-lowering agent ivabradine, even in patients on beta-blockers. The BEAUTIFUL trial showed that in patients with a heart rate of 70 b.p.m. or more, ivabradine significantly reduced hospitalisation for fatal and non-fatal myocardial infarction or hospitalisation for heart failure and coronary revascularisation. In the SHIFT, heart rate reduction with ivabradine improved clinical outcomes. Therefore, high heart rate represents an important risk factor the effects of which can be reversed by ivabradine in patients with coronary artery disease or heart failure with or without background beta-blocker therapy. © The Author 2011.