Heart Rate as a Marker of Cardiovascular Prognosis

Although several studies have shown that elevated heart rate (HR) is a powerful, independent, and consistent predictor of cardiovascular events and all-cause mortality, it is still considered an epiphenomenon of a general disorder rather than an independent risk factor. Several questions regarding the clinical significance of a resting HR as marker of cardiovascular risk are still unanswered, rendering the inclusion of this hemodynamic variable in the list of cardiovascular risk factors problematic, at least for time being. This paper will examine which HR value better reflects the cardiovascular risk, the predictive power, the complex pathophysiological mechanisms underlying the relationship between HR and cardiovascular risk. It will evaluate whether HR should be considered a true risk factor for cardiovascular diseases or simply a marker of autonomic imbalance, and finally, it will consider the effects of HR reduction on cardiovascular morbidity.