Elevated heart rate is also a risk factor after cardiac transplantation: Time to slow down?

Abstract

Throughout history heart rate has been recognized as an important physiological sign and even in early medical literature it was reported that elevated heart rate might carry prognostic information in patients [ [1] Ferrari R. The story of the heartbeat, I: part I—heart rate: the rhythm of life. Eur Heart J. 2012; 33: 4-5 PubMed Google Scholar ]. In recent years cardiologists have rediscovered this phenomenon, most likely due to the fact that specific heart rate lowering pharmacological therapy has become available [ [2] Cargnoni A. Ceconi C. Stavroula G. Ferrari R. Heart rate reduction by pharmacological If current inhibition. Adv Cardiol. 2006; 43: 31-44 Crossref PubMed Scopus (10) Google Scholar ]. In fact, numerous studies published within the last 10 years have effectively documented that elevated heart rate is an important, independent risk factor for adverse outcome in apparently healthy people [ [3] Cooney M.T. Vartiainen E. Laatikainen T. Juolevi A. Dudina A. Graham I.M. Elevated resting heart rate is an independent risk factor for cardiovascular disease in healthy men and women. Am Heart J. 2010; 159 ([e3]): 612-619 Abstract Full Text Full Text PDF PubMed Scopus (301) Google Scholar ] as well as in patients with individual risk factors such as diabetes [ [4] Hillis G.S. Hata J. Woodward M. et al. Resting heart rate and the risk of microvascular complications in patients with type 2 diabetes mellitus. J Am Heart Assoc. 2012; 1: e002832 Crossref Scopus (46) Google Scholar ], hypertension [ [5] Julius S. Palatini P. Kjeldsen S.E. et al. Usefulness of heart rate to predict cardiac events in treated patients with high-risk systemic hypertension. Am J Cardiol. 2012; 109: 685-692 Abstract Full Text Full Text PDF PubMed Scopus (94) Google Scholar ] or smoking [ [6] Jensen M.T. Marott J.L. Jensen G.B. Elevated resting heart rate is associated with greater risk of cardiovascular and all-cause mortality in current and former smokers. Int J Cardiol. 2011; 151: 148-154 Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar ]. Furthermore, elevated heart rate is associated with poor outcome across the entire spectrum of established cardiovascular disease from stable ischemic heart disease [ [7] Diaz A. Bourassa M.G. Guertin M.C. Tardif J.C. Long-term prognostic value of resting heart rate in patients with suspected or proven coronary artery disease. Eur Heart J. 2005; 26: 967-974 Crossref PubMed Scopus (684) Google Scholar ] to myocardial infarction [ [8] Antoni M.L. Boden H. Delgado V. et al. Relationship between discharge heart rate and mortality in patients after acute myocardial infarction treated with primary percutaneous coronary intervention. Eur Heart J. 2012; 33: 96-102 Crossref PubMed Scopus (60) Google Scholar ] and at the end of the spectrum, heart failure with either preserved [ [9] Kapoor J.R. Heidenreich P.A. Heart rate predicts mortality in patients with heart failure and preserved systolic function. J Card Fail. 2010; 16: 806-811 Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar ] or reduced ejection fraction [ 10 Fosbol E.L. Seibaek M. Brendorp B. et al. Long-term prognostic importance of resting heart rate in patients with left ventricular dysfunction in connection with either heart failure or myocardial infarction: the DIAMOND study. Int J Cardiol. 2010; 140: 279-286 Abstract Full Text Full Text PDF PubMed Scopus (51) Google Scholar , 11 Bohm M. Swedberg K. Komajda M. et al. Heart rate as a risk factor in chronic heart failure (SHIFT): the association between heart rate and outcomes in a randomised placebo-controlled trial. Lancet. 2010; 376: 886-894 Abstract Full Text Full Text PDF PubMed Scopus (690) Google Scholar ].