Heart rate and cardiovascular protection

• RHR is an independent risk factor for overall and cardiovascular-related mortality.
• Sustained elevation of RHR may reflect sympathovagal imbalance.
• Elevated RHR favors endothelial dysfunction and progression of atherosclerosis.
• The advantages of RHR reduction in CV disease have been proved in clinical trials.
• Heart rate lowering treatment's benefits in healthy subjects are not yet defined.

Recent large epidemiological studies have confirmed that an elevated resting heart rate is an independent predictor of cardiovascular and overall mortality in the general population as well as in patients with hypertension, coronary heart disease and chronic heart failure. Pathophysiological studies indicate that a higher heart rate has detrimental effects that favor myocardial ischemia, ventricular arrhythmias, as well as an increase in vascular oxidative stress, endothelial dysfunction and atherosclerosis progression. Benefits of heart rate lowering drugs, such as beta-blockers and ivabradine, in reducing overall and cardiovascular-related mortality, have been demonstrated particularly in patients with coronary heart disease and heart failure. However, despite these evidences, resting heart rate is still an overlooked cardiovascular risk factor.