European Heart Journal Advance Access published online on October 1, 2008
European Heart Journal, doi:10.1093/eurheartj/ehn447
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High resting heart rate: a cardiovascular risk factor or a marker of risk?
Department of Cardiology
Hospital Infanta Sofia
Paseo de Europa 34
28702 San Sebastian de los Reyes, Madrid
Spain
Tel: +34 91 336 8259
Fax: +34 91 336 8665
Email: escobar_cervantes_carlos{at}hotmail.com
Department of Cardiology
Hospital Ramón y Cajal
Madrid
Spain
We read with interest the work of Kolloch et al.1 about the relationship between resting heart rate (RHR) and adverse events in patients with hypertension and coronary artery disease from the population of the INternational VErapamil-SR/trandolapril STudy (INVEST study). This study reported that higher baseline and follow-up RHR were associated with increased adverse outcome risks. Taking into account that this study showed that, despite the atenolol-based strategy reduced the RHR more than verapamil-based strategy, adverse events were similar in both groups; the key question is whether this worse prognosis is because the higher RHR is associated with poorer outcomes by itself or because it is related with other cardiovascular risk factors and organ damage and this is what really increases the risk of presenting adverse events. In other words, is high RHR a cardiovascular risk factor or a marker of risk?
Although this study highlighted that some baseline characteristics such as diabetes and heart failure added more risk than RHR, there is still lack of information about this matter. It has been reported that the hypertensive population with coronary heart disease and high RHR present more frequently diabetes, organ damage, and higher blood pressure values, and worse lipid and fasting glucose profiles, when compared with population with lower RHR. Although the number of drugs were similar regardless HR values, cardiovascular risk factors control rates (blood pressure, LDL-cholesterol and diabetes) were significantly worse in patients with high RHR.2
Although more data are warranted to clarify whether high RHR is a risk factor or a marker of risk, it seems to be clear that high RHR is associated with a poor prognosis in hypertensive population with coronary heart disease. However, it remains still unknown whether modulation of HR could improve prognosis.3
Since there is lack of information about the real importance of high RHR, to date, current guidelines do not still recognize HR as a cardiovascular risk factor.4 However, since high RHR is associated with a worse clinical profile, it appears necessary that physicians pay more attention to it.
References
- Kolloch R, Legler UF, Champion A, Cooper-Dehoff RM, Handberg E, Zhou Q, Pepine CJ. Impact of resting heart rate on outcomes in hypertensive patients with coronary artery disease: findings from the INternational VErapamil-SR/trandolapril STudy (INVEST). Eur Heart J (2008) 29:1327–1334.
[Abstract/Free Full Text] - Barrios V, Escobar C, Bertomeu V, Murga N, De Pablo C, Asin E. High heart rate: more than a risk factor. Lessons from a clinical practice survey. Int J Cardiol (2008) [Epub ahead of print].
- Fox K, Borer JS, Camm AJ, Danchin N, Ferrari R, Lopez Sendon JL, Steg PG, Tardif JC, Tavazzi L, Tendera M. Heart Rate Working Group. Resting heart rate in cardiovascular disease. J Am Coll Cardiol (2007) 50:823–830.
[Abstract/Free Full Text] - Smith SC Jr, Allen J, Blair SN, Bonow RO, Brass LM, Fonarow GC, Grundy SM, Hiratzka L, Jones D, Krumholz HM, Mosca L, Pasternak RC, Pearson T, Pfeffer MA, Taubert KA. AHA/ACC; National Heart, Lung, and Blood Institute. AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update: endorsed by the National Heart, Lung, and Blood Institute. Circulation (2006) 113:2363–2372.
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