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European Heart Journal Advance Access originally published online on July 4, 2005
European Heart Journal 2005 26(17):1807; doi:10.1093/eurheartj/ehi399
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© The European Society of Cardiology 2005. All rights reserved. For Permissions, please e-mail: journals.permissions@oupjournals.org

Heart rate reduction through lifestyle modification: reply

Jean-Claude Tardif

Research Center
Montreal Heart Institute Coordinating Center
Montreal Heart Institute
5000 Belanger Street E
Montreal H1T 1C8
Canada
Tel: +1 514 376 3330
Fax: +1 514 376 3330
E-mail address:
jean-claude.tardif{at}icm-mhi.org

Ariel Diaz

Research Center
Montreal Heart Institute Coordinating Center
Montreal Heart Institute
5000 Belanger Street E
Montreal H1T 1C8
Canada

Martial G. Bourassa

Research Center
Montreal Heart Institute Coordinating Center
Montreal Heart Institute
5000 Belanger Street E
Montreal H1T 1C8
Canada

We thank Drs Michalsen and Dobos for their comments. Resting heart rate is indeed a strong predictor of mortality in patients with coronary artery disease.1 Experimental data have demonstrated that a reduction in heart rate can delay the progression of atherosclerosis in animal models.2 Atherosclerosis progression has also been shown to be predicted independently by minimum heart rate in men after myocardial infarction.3 Coronary artery endothelial cell dysfunction associated with high heart rates may represent an important mechanism for increased atherogenesis.4 In addition, a mean heart rate >80 b.p.m. has also been shown to be associated with a higher risk of atherosclerotic plaque disruption.3

Drs Michalsen and Dobos are correct in pointing out that the extent of heart rate reduction with beta-blockade is related to the decrease in cardiovascular events after myocardial infarction. We entirely agree that non-pharmacological options to heart rate reduction should be evaluated and compared with pharmacological approaches. However, it is unfortunately often difficult to obtain significant lifestyle changes (such as exercise and diet) in large number of patients in the clinical setting. Because beta-blockers may have other actions including the unmasking of alpha-adrenergic-mediated coronary vasoconstriction and deleterious changes in lipid and glucose metabolism, it may also be very interesting to evaluate the effects of a pure heart rate-reducing agent that selectively acts on the sino-atrial node such as the If channel inhibitor ivabradine.5 The clinical efficacy of directly targeting heart rate reduction to decrease morbidity and mortality needs to be determined in patients with coronary artery disease.

References

  1. 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]
  2. Beere PA, Glagov S, Zarins CK. Retarding effect of lowered heart rate on coronary atherosclerosis. Science 1984;226:180–182.[Abstract/Free Full Text]
  3. Tardif JC, Grégoire J, L'Allier PL, Joyal M. Chronic heart rate reduction with ivabradine and prevention of atherosclerosis progression assessed by intravascular ultrasound. Eur Heart J 2003;5(Suppl. G):G46–G51.[CrossRef]
  4. Skantze HB, Kaplan J, Pettersson K, Manuck S, Blomqvist N, Kyes R, Williams K, Bondjers G. Psychosocial stress causes endothelial injury in cynomolgus monkeys via beta1-adrenoceptor activation. Atherosclerosis 1998;136:153–161.[CrossRef][Web of Science][Medline]
  5. Tardif JC. Clinical efficacy of ivabradine. Heart Drug 2005;5:25–28.

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This Article
Right arrow FREE Full Text (PDF) Freely available
Right arrow All Versions of this Article:
26/17/1807    most recent
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