A Consensus Statement on the Role of Bisoprolol across the CV Continuum

Cardiovascular disease (CVD) remains the leading cause of death globally, affecting populations in both developed and low- and middle-income countries. Although age-adjusted mortality rates from coronary artery disease (CAD) have declined in regions such as the United States and Europe, sudden cardiac death continues to account for a significant proportion of CVD-related fatalities. The concept of the "cardiovascular continuum," introduced more than a decade ago, describes the progressive nature of CVD-beginning with modifiable risk factors such as hypertension, diabetes, and smoking, which collectively drive oxidative stress, endothelial dysfunction, and inflammation. Over time, these pathophysiological changes lead to atherosclerosis and end-organ damage, often well before clinical symptoms become apparent.

In India, the burden of CVD has risen sharply in recent decades, particularly due to increasing rates of coronary heart disease and cerebrovascular events. Emerging evidence identifies an elevated resting heart rate as an independent predictor of adverse cardiovascular outcomes, particularly in individuals with hypertension, myocardial infarction (MI), and heart failure (HF). Among available pharmacological options, beta-blockers-particularly bisoprolol-have demonstrated strong efficacy in managing angina, atrial fibrillation (AF), and heart failure with reduced ejection fraction (HFrEF). By acting at multiple stages of the cardiovascular continuum, bisoprolol provides both symptomatic relief and disease-modifying effects, underscoring its importance in contemporary cardiovascular management.