Heart rate as an independent risk factor for cardiovascular disease: current evidence and basic mechanisms.

Mounting evidence shows that elevated heart rate (>80-85 beats/min) measured under resting conditions is directly associated with risk of developing hypertension and atherosclerosis, and is a potent predictor of cardiovascular morbidity and mortality. Several epidemiological studies have shown that these relationships are independent of other risk factors for atherosclerosis, and are present in individuals free of disease as well as in patients with cardiovascular disease. Experimental and clinical studies suggest that the haemodynamic disturbances related to elevated heart rate have a direct impact on the arterial wall, promoting the development of atherosclerotic plaques. In addition, heart rate has been directly related to the development of cardiovascular events associated with plaque disruption, which is statistically more likely as heart rate increases. In light of this evidence, heart rate should be included among the major risk factors for coronary heart disease.