European Heart Journal Advance Access originally published online on July 4, 2005
European Heart Journal 2005 26(17):1806-1807; doi:10.1093/eurheartj/ehi398
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Heart rate reduction through lifestyle modification
Department of Internal Medicine V
Kliniken Essen-Mitte
Am Deimelsberg 34a
Essen 45276
Germany
Tel: +49 201 8054002
Fax: +49 201 8054005
E-mail address:
andreas.michalsen{at}uni-essen.de
Department of Internal Medicine V
Kliniken Essen-Mitte
Am Deimelsberg 34a
Essen 45276
Germany
We read with great interest the article of Diaz et al.1 reporting on the long-term prognostic value of resting heart rate. In the accompanying editorial of Palatani,2 the role of heart rate as a strong predictor in subjects with coronary artery disease is emphasized. Palatini further points to the important fact that beta-blocking therapy in survivors of myocardial infarction or patients with congestive heart failure was effective only in subjects with high heart rate at baseline and was completely ineffective in those with low heart rate. Although it remains unclear whether beta-blocker therapy in coronary patients should be targeted according to pre-treatment heart rates, it is important to note that heart rate is also largely affected by lifestyle-related factors.
The decreased heart rate of endurance athletes is well known,3 and in recent studies on coronary patients, exercise therapy that led to meaningful, clinically beneficial effects was associated with significant heart rate reduction.4 In addition, high intake of docosahexaenoic n-3 fatty acid, an essential feature of the Mediterranean diet, is associated with decreased heart rate.5 Finally, sympathetic dominance with higher heart rates may be enhanced by anxiety and depression. Elicitation of the relaxation response and meditation have been shown to decrease adrenergic receptor sensitivity and to increase parasympathetic activity, thereby leading to reduction of heart rate.6,7
Therefore, in the clinical approaches to reduce heart rate in coronary patients, effective non-pharmacological options should also be considered.
Further studies may also clarify whether non-pharmacological heart rate reduction may have a comparable protective efficacy as that of beta-blocking agents in primary and secondary prevention of myocardial infarction.
References
- Diaz A, Bourassa MG, Guertin MC, Tardif JC. Long-term prognostic value of resting heart rate in patients with suspected or proven coronary artery disease. Eur Heart J 2005;26:967–974.
[Abstract/Free Full Text] - Palatini P. Heart rate: a strong predictor of mortality in subjects with coronary artery disease. Eur Heart J 2005;26:943–945.
[Free Full Text] - Carter JB, Banister EW, Blaber AP. Effect of endurance exercise on autonomic control of heart rate. Sports Med 2003;33:33–46.[CrossRef][ISI][Medline]
- Hambrecht R, Walther C, Mobius-Winkler S, Gielen S, Linke A, Conradi K, Erbs S, Kluge R, Kendziorra K, Sabri O, Sick P, Schuler G. Percutaneous coronary angioplasty compared with exercise training in patients with stable coronary artery disease: a randomized trial. Circulation 2004;109:1371–1378.
[Abstract/Free Full Text] - Mori TA, Bao DQ, Burke V, Puddey IB, Beilin LJ. Docosahexaenoic acid but not eicosapentaenoic acid lowers ambulatory blood pressure and heart rate in humans. Hypertension 1999;34:253–260.
[Abstract/Free Full Text] - Mills PJ, Schneider RH, Hill D, Walton KG, Wallace RK. Beta-adrenergic receptor sensitivity in subjects practicing transcendental meditation. J Psychosom Res 1990;34:29–33.[CrossRef][ISI][Medline]
- Hoffman JW, Benson H, Arns PA, Stainbrook GL, Landsberg GL, Young JB, Gill A. Reduced sympathetic nervous system responsivity associated with the relaxation response. Science 1982;215:190–192.
[Abstract/Free Full Text]
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