Heart rate reduction through lifestyle modification

doi:10.1093/eurheartj/ehi398 Heart rate reduction through lifestyle modification We read with great interest the article of Diaz et al.1 reporting on the long-term prog-nostic value of resting heart rate. In the accompanying editorial of Palatani,2 the role of heart rate as a strong predictor in subjects with coronary artery disease is emphasized. Palatini further points to the important fact that beta-blocking therapy in survivors of myocardial infarction or patients with congestive heart failure was effective only in subjects with high heart rate at baseline and was completely ineffec-tive in those with low heart rate. Although it remains unclear whether beta-blocker therapy in coronary patients should be targeted according to pre-treatment heart rates, it is important to note that heart rate is also largely affected by lifestyle-related factors. The decreased heart rate of endurance athletes is well known,3 and in recent studies on coronary patients, exercise therapy that led to meaningful, clinically beneficial effects was associated with signifi-cant heart rate reduction.4 In addition, high intake of docosahexaenoic n-3 fatty acid, an essential feature of the Mediterranean diet, is associated with decreased heart rate.5 Finally, sympathetic dominance with higher heart rates may be enhanced by anxiety and depression. Elicitation of the relaxation response and meditation have been shown to decrease adrenergic receptor sensitivity and to increase parasympathetic activity, thereby leading to reduction of heart rate.6,7 Therefore, in the clinical approaches to reduce heart rate in coronary patients, effective non-pharmacological options should also be considered. Further studies may also clarify whether non-pharmacological heart rate reduction may have a comparable protective efficacy as that of beta-blocking agents in primary and secondary preventionofmyocardial infarction.