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Elevated heart rate and cardiovascular outcomes in patients with coronary artery disease: Clinical evidence and pathophysiological mechanisms

Lookup NU author(s): Dr Samir Gupta, Professor Bernard Keavney

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Abstract

There is an established body of evidence from epidemiological studies which indicates that an elevated resting heart rate is independently associated with atherosclerosis and increased cardiovascular morbidity and mortality, in both the general population and inpatients with established cardiovascular disease. Clinical trial data suggest that in patients with coronary artery disease, an elevated heart rate identifies those at increased risk of adverse cardiovascular outcomes, and that lowering of heart rate may reduce major cardiovascular events in patients with an elevated heart rate and symptom-limiting angina. These results suggest that an increased heart rate may have an adverse impact on the atherosclerotic process and increase the risk of a cardiovascular event inpatients with coronary artery disease. The precise pathophysiological mechanisms that link heart rate and cardiovascular outcomes have yet to be defined. Possibilities may include indirect mechanisms related to autonomic dysregulation and those due to an increase in heart rate per se, which can increase the ischaemic burden and exert local haemodynamic forces that can adversely impact on the endothelium and arterial wall. For these reasons, heart rate should be considered as a therapeutic target in the treatment of patients with coronary artery disease. (C) 2010 Elsevier Ireland Ltd. All rights reserved.

Publication metadata

Author(s): Lang CC, Gupta S, Kalra P, Keavney B, Menown I, Morley C, Padmanabhan S

Publication type: Review

Publication status: Published

Journal: Atherosclerosis

Year: 2010

Volume: 212

Issue: 1

Pages: 1-8

Print publication date: 29/01/2010

ISSN (print): 0021-9150

ISSN (electronic): 1879-1484

URL: http://dx.doi.org/10.1016/j.atherosclerosis.2010.01.029

DOI: 10.1016/j.atherosclerosis.2010.01.029

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