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[Heart rate: a risk factor or an epiphenomenon?]
Marco Metra1, Valerio Zacà, Carlo Lombardi
1Cardiologia, Dipartimento di Medicina Sperimentale ed Applicata, Università degli Studi e Spedali Civili, Brescia. metramarco@libero.it
Giornale Italiano Di Cardiologia (2006)
|June 17, 2010
Summary
Elevated heart rate (HR) predicts cardiovascular events in coronary artery disease patients. Ivabradine reduced ischemic events by lowering HR, but not mortality, in the BEAUTIFUL trial.
Area of Science:
- Cardiology
- Clinical Trials
- Pharmacology
Background:
- The prognostic significance of heart rate (HR) in cardiovascular disease is debated.
- Direct causal evidence linking HR to prognosis is limited.
- Ivabradine offers a unique tool to investigate HR's causal role.
Purpose of the Study:
- To evaluate HR as a prognostic predictor in coronary artery disease (CAD) with left ventricular systolic dysfunction.
- To assess the effect of HR reduction with ivabradine on cardiovascular outcomes.
Main Methods:
- The BEAUTIFUL trial investigated patients with CAD and left ventricular systolic dysfunction.
- Participants with resting HR >70 bpm were analyzed.
- Treatment with ivabradine aimed to reduce HR.
Main Results:
- Resting HR >70 bpm identified patients at increased risk for major adverse cardiovascular events.
- HR reduction with ivabradine decreased major cardiac ischemic events.
- Ivabradine did not significantly reduce mortality in this population.
Conclusions:
- HR is a significant negative prognostic predictor in CAD patients with systolic dysfunction.
- Targeting HR with ivabradine can reduce ischemic events.
- Further research, including the SHIFT trial, is needed to confirm effects on mortality and heart failure hospitalizations.
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