Heart Rate as a Therapeutic Target in Angina Pectoris

Emmanuel      Androulakis; Dimitris      Tousoulis; Nikolaos      Papageorgiou; Anna      Kontogeorgou; Alexandros      Briasoulis; Marietta      Charakida; Gerasimos      Siasos; Evangelos      Oikonomou; Katerina      Siama; George      Latsios; Christodoulos      Stefanadis

Abstract

Heart rate is a major determinant of cardiac output and myocardial oxygen utilization and is increasingly being nominated as a modifiable risk factor for cardiovascular disease. Despite this evidence, screening strategies for preventing cardiovascular diseases do not include routine assessment of resting heart rate. Reasonably, heart rate reduction has been suggested as a useful approach against angina pectoris in subjects with acute or chronic coronary syndromes. Accordingly, reduction of heart rate in patients with stable angina could be an additional goal of therapy. Important data have shown retrospectively the beneficial effect of heart rate-lowering drugs, such as betaadrenoceptor antagonists, non-dihydropyridine calcium channel antagonists, as well as other agents, on several parameters in patients with coronary artery disease and stable angina. However, additional data are now being sought to assess the impact of this approach on clinical practice.

Keywords: Stable angina, heart rate, therapeutic target, beta-blockers, ivabradine, ranolazine, cardiac output, myocardial oxygen, cardiovascular diseases, non-dihydropyridine calcium channel