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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

Heart rate and atherosclerosis

Jean-Claude Tardif*

Department of Medicine, Montreal Heart Institute and University of Montreal, 5000 Belanger Street, Montreal H1T 1C8, Canada

* Corresponding author. Tel: +1 514 376 3330, Fax: +1 514 593 2500, E-mail address: jean-claude.tardif{at}icm-mhi.org

Heart rate (HR) is a potent predictor of major cardiovascular events in both the general population and the patients with various cardiovascular diseases. An increased HR has been shown to be associated with increased progression of coronary atherosclerosis in animal models and patients. A high HR has also been associated with a greatly increased risk of plaque rupture in patients with coronary atherosclerosis. Pure HR reduction has slowed atherosclerosis progression in experimental models. Endothelial function may be an important link between HR and atherosclerosis. An increased HR has been shown experimentally to cause endothelial dysfunction. The protective effect on the endothelium of long-term pure HR reduction with ivabradine that we have shown in a dyslipidaemic mouse model of endothelial dysfunction could provide an important mechanism for the potential vascular benefits of the If current inhibitor ivabradine. These results, in addition to those of the BEAUTIFUL study, constitute a strong rationale for further clinical investigation of the cardioprotective effects of pure HR reduction.

Key Words: Heart rate • Atherosclerosis • Coronary artery disease • Plaque rupture


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