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The heart rate hypothesis: ready to be tested
1British Heart Foundation Heart Research Centre at Leeds, University of Leeds, Leeds, UK. A.S.Hall@leeds.ac.uk
Insights
Elevated heart rate is a significant risk factor for cardiovascular events. Reducing heart rate may lower cardiovascular morbidity and mortality, a hypothesis now testable with new selective heart rate-lowering drugs.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Increased heart rate is linked to cardiovascular morbidity and mortality in various populations.
- Elevated heart rate exacerbates myocardial oxygen demand and ischemia in coronary artery disease.
- Resting heart rate may influence atherosclerosis, plaque stability, and arrhythmias.
Purpose of the Study:
- To evaluate the role of heart rate as an independent risk factor for cardiovascular disease.
- To assess the potential benefits of heart rate reduction in managing ischemic heart disease and angina.
- To investigate the efficacy of novel selective heart rate-lowering drugs.
Main Methods:
- Review of existing evidence on heart rate and cardiovascular outcomes.
- Analysis of the impact of heart rate on myocardial oxygen consumption and ischemia.
- Consideration of pharmacological interventions targeting heart rate.
Main Results:
- Evidence suggests elevated heart rate is an independent risk factor for cardiovascular events.
- Heart rate reduction is a key therapeutic goal in stable angina pectoris.
- Existing heart rate-lowering treatments may have confounding negative inotropic effects.
Conclusions:
- The heart rate hypothesis warrants further investigation.
- Selective heart rate-lowering drugs offer a new avenue to test this hypothesis.
- Targeting heart rate may reduce cardiovascular morbidity and mortality in patients with ischemic heart disease.
Abstract:
There is increasing evidence that increased heart rate may be an independent risk factor for cardiovascular morbidity and mortality both in patients with ischaemic heart disease and in the general population. Elevated heart rate in coronary artery disease is a major determinant of oxygen consumption and appears to evoke most episodes of ischaemia. Increased resting heart rate may also contribute to the development of atherosclerosis, facilitate plaque destabilisation and initiate arrhythmias, leading to acute coronary events and sudden death. Reducing heart rate is a central aim in the treatment of stable angina pectoris; this therapeutic approach may have an essential role in lowering the incidence of cardiovascular morbidity and mortality in patients with pre-existing ischaemic heart disease. However, this heart rate hypothesis has not thus far been proven. Evidence suggests that the use of heart rate-lowering drugs may have a beneficial effect; however, most treatments for angina have additional negative inotropic effects on the heart. This hypothesis can now be tested following the recent development of selective heart rate drugs.
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