Elevated heart rate: a "new" cardiovascular risk factor?

A number of epidemiologic studies and several experimental lines of research point to high heart rate as a main risk factor for cardiovascular disease. However, translating research into clinical practice has been a challenge throughout medical history. From the present symposium, it appears clear that this is particularly the case for heart rate. The complex nature of atherogenesis makes it difficult to establish the role of a putative risk factor because of the correlations and complex interactions among factors. The pathogenetic mechanisms for the connection of resting heart rate with atherosclerosis and cardiovascular morbidity have been elaborated extensively in the chapter papers of this symposium, suggesting that there is a causal relationship between heart rate and cardiovascular mortality. The benefit of heart rate reduction has been proved in patients with coronary artery disease or congestive heart failure. Until now it has been difficult to determine whether modulation of heart rate is beneficial also in patients free of cardiac diseases. This concern, however, does not in any fashion suggest that health care professionals should pay less attention to this clinical variable. The impressive amount of available epidemiologic data show support for the continued effort to raise awareness of the clinical importance of resting heart rate among health care professionals.