The pivotal role of heart rate in clinical practice: from atherosclerosis to acute coronary syndrome

Heart rate is a predictor of major cardiovascular events in both the general population and patients with various cardiovascular diseases. The association between resting heart rate and mortality has been observed in patients with hypertension and with metabolic syndrome and in the elderly. The prognostic value of heart rate has also been shown in patients with stable coronary heart disease. We assessed the relationship between resting heart rate at baseline and cardiovascular mortality and morbidity, while adjusting for risk factors. A total of 24 913 patients with suspected or proven coronary artery disease from the Coronary Artery Surgery Study registry were studied for a median follow-up of close to 15 years. All-cause and cardiovascular mortality and cardiovascular re-hospitalizations were increased with increasing heart rate (P < 0.0001). When compared with the reference group, patients with resting heart rate ≥83 bpm at baseline had a significantly higher risk for total mortality [hazard ratio 1.32; confidence interval (CI) 1.19–1.47; P < 0.0001] and cardiovascular mortality (hazard ratio 1.31; CI 1.15–1.48; P < 0.0001) after adjustment for multiple clinical variables. When comparing patients with heart rates between 77–82 and ≥83 bpm with patients with a heart rate ≤62 bpm, the hazard ratios for time to first cardiovascular re-hospitalization were 1.11 and 1.14 (P < 0.001 for both). Resting heart rate has also been shown to be associated with the severity and rate of progression of coronary atherosclerosis and to be an independent predictor of plaque rupture in coronary arteries. Resting heart rate is a simple measurement with prognostic implications.