Heart rate lowering reduces cardiovascular disease burden

Dear Editor,

We read the ATHENA study by Kobalava et al. with interest1. This registry conducted in 20 cardiology and general practices in Russia investigated the achievement of optimal resting heart rate (HR <60 beats/min) with beta-blockers in 399 patients with stable ischemic heart disease (IHD) and primary hypertension. The study concludes that resting HR control in these patients is suboptimal. Such studies may increase awareness regarding HR control. HR is an easily measurable, reproducible and inexpensive predictor of IHD-related morbidity and mortality2.

The study, by design, did not compare clinical outcomes. This gap is covered by several large studies suggesting the importance of low HR in cardiovascular disease2. It seems that the effect of low HR on local hemodynamic milieu (i.e. shear stress and tensile stress) plays a key role3. Low HR attenuates the magnitude and frequency of tensile stress on the arterial wall and reduces the exposure of coronary endothelium to the systolic low and oscillatory endothelial shear stress, thereby creating a less pro-atherogenic microenvironment3.

Experimental and clinical studies elucidating the involvement of local hemodynamics are needed. Despite the lack of definitive pathobiologic evidence, clinical studies support the contribution of HR lowering in decreasing cardiovascular morbidity and mortality.

Transparency

Declaration of funding

This letter was not funded.

Declaration of financial or other relationships

G.D.G. and Y.S.C. have disclosed that they have no significant relationships with or financial interests in any commercial companies related to this study or article.