Interní Med. 2009; 11(7): 315-318

Heart rate and cardiovascular disease

prof. MUDr. Lenka Špinarová Ph.D., FESC, prof. MUDr. Jiří Vítovec CSc., FESC

I. interní kardioangiologická klinika FN u sv. Anny v Brně

Heart rate is a risk factor for cardiovascular morbidity and mortality in the general population as well as in patients already treated for

cardiovascular disease. In the placebo arm of the SYST-EUR study in hypertensives, heart rate was a significant risk factor; similarly, in

patients after myocardial infarction in the GISSI 3 study, mortality increased with increasing heart rate. Increased heart rate is a risk factor

in patients with heart failure. The heart rate of 50–70 beats/min appears to be optimal.

Four principal drug groups are used to lower heart rate: digitalis, beta blockers, calcium channel blockers of the phenylalkylamine

class, and If channel blockers. Digitalis is fully indicated in patients with heart failure and atrial fibrillation; however, it failed to reduce

mortality in the DIG study in patients with a sinus rhythm. Beta blockers are used to treat hypertension, ischaemic heart disease, and

heart failure and have been shown to reduce mortality in all the indications. It is not clear, however, to which extent this effect is due to

negative chronotropic action and to which due to other, particularly antiarrhythmic, effects. In patients after myocardial infarction in

the INVEST study, verapamil had an effect comparable to that of the beta blockers; in the DAVIT 2 study, it resulted in a 20 % decrease in

cardiovascular events. If channel blockers failed to reduce mortality in the „BEAUTIFUL“ study and continue being intensively tested.

Keywords: heart rate, mortality, digitalis, beta blockers, verapamil.

Published: September 1, 2009  Show citation