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Published on: July 21, 2023
Heart rate as a possible therapeutic guide for the prevention of cardiovascular disease
Taku Inoue1, Kunitoshi Iseki, Yusuke Ohya
11] Center of Residency and Fellowship Program, University Hospital of the Ryukyus, Nishihara, Japan [2] Department of Cardiovascular Medicine, Nephrology and Neurology, Faculty of Medicine, University of the Ryukyus, Nishihara, Japan.
Insights
Elevated heart rate (HR) predicts mortality. Targeting HR, not just as a risk indicator but as a therapeutic goal, is crucial for cardiovascular health and managing patient outcomes.
Area of Science:
- Cardiology
- Clinical Epidemiology
Background:
- Elevated heart rate (HR) is a significant independent predictor of all-cause and cardiovascular (CV) mortality.
- Ivabradine, a heart rate-lowering agent, has shown efficacy in reducing CV events in patients with coronary artery disease (CAD) and chronic heart failure.
- An HR exceeding 70 beats per minute (b.p.m.) is associated with increased hazard.
Purpose of the Study:
- To highlight that elevated HR is not merely a marker of CV risk but a modifiable therapeutic target.
- To emphasize the prognostic value of in-treatment HR and HR changes for mortality prediction, irrespective of the HR-lowering strategy used.
- To explore the role of HR modulation in risk management and address concerns about beta-blocker-induced HR reduction.
Main Methods:
- Review of epidemiologic evidence linking HR to mortality.
- Analysis of clinical trial data on HR-lowering agents like ivabradine.
- Examination of studies evaluating in-treatment HR and HR changes as predictors of CV outcomes.
Main Results:
- Epidemiologic data confirm HR as an independent predictor of all-cause and CV mortality.
- In-treatment HR and HR changes independently predict subsequent mortality, offering guidance for risk management.
- Concerns exist regarding potential adverse effects of beta-blocker-mediated HR reduction on CV event prevention.
Conclusions:
- Elevated HR is a critical therapeutic target, not just an epiphenomenon of CV risk.
- In-treatment HR and its changes are valuable indicators for guiding risk management strategies.
- The role of HR modulation warrants consideration in future cardiovascular clinical practice guidelines.
Abstract:
Epidemiologic evidence indicates that an elevated heart rate (HR) is an independent predictor of all-cause and cardiovascular (CV) mortality. Ivabradine, a pure HR-lowering agent, reduces CV events in patients with coronary artery disease (CAD) and chronic heart failure, and indicate that an HR greater than 70 b.p.m. is hazardous. These findings demonstrate not only that an elevated HR is an epiphenomenon of CV risk status but also that an elevated HR itself should be a therapeutic target. In addition, recent epidemiologic evidence demonstrates that the in-treatment HR or HR change predicts subsequent all-cause and CV mortality, independent of the HR-lowering strategy. Characteristics of the in-treatment HR or HR change are also important as possible therapeutic guides for risk management. However, there have been concerns regarding deleterious effects on CV event prevention owing to β-blocker-derived pharmacologic HR reduction. The potential role of HR and its modulation should be considered in future guidance documents.
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