Heart rate management: a therapeutic goal throughout the cardiovascular continuum

A number of physiological pathways and risk factors leading to cardiovascular disease (CVD) are now well identified, although there are still aspects to be investigated. An interesting concept has been developed called the CVD continuum which frames CVD as a chain of events initiated by a number of risk factors leading to end stage of the disease with the hypothesis that any interruption along this chain of events may interrupt the pathological process thereby conferring cardiovascular prevention. In recent years, heart rate (HR), a simple and familiar clinical finding, has been shown to be an independent risk factor of mortality and morbidity in various populations including patients with CVDs. This review shows that high HRs intervene along the chain of events which constitutes the cardiovascular continuum promoting CVD. Experimental data and clinical observations that demonstrate the major role played by resting HR in the pathophysiology of atherosclerosis through the stress exerted on the vascular endothelium leading to atherosclerotic lesion formation and plaque rupture are reviewed. Therefore, HR reduction should lead to prevention of atherosclerosis and therefore to the reduction of cardiovascular events. Trials have been undertaken to answer this question and the results are expected in the near future.