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Elevated heart rate linked to men's heart failure.


ROME -- Otherwise healthy, older men with a heart rate of 79 beats per minute or higher had a roughly 50% increased risk of developing heart failure, compared with men with slower heart rates, in a population-based cohort of more than 1,800 Dutch men.

The finding suggests that heart rate, independent of any other cardiovascular risk factor, could boost the risk for developing heart failure, and raises the possibility of trying to dampen this effect by using interventions to reduce heart rate, Dr. David Nanchen said at the annual meeting of the European Society of Cardiology.

But the apparent link between resting heart rate and a boosted incidence of heart failure during follow-up occurred only in men. The analysis also included 2,939 women, who showed no suggestion of an association between baseline heart rate and subsequent development of heart failure.

The work reported by Dr. Nanchen also included an analysis that censored men who had an incident myocardial infarction during a median follow-up of 15 years, thereby eliminating cases of heart failure that occurred following an MI. In this analysis, men with a baseline heart rate of 79 beats per minute or greater had a statistically significant, 56% increased incidence of heart failure compared with men with an entry heart rate of less than 69 beats per minute, said Dr. Nanchen, head of the cardiovascular preventative clinic of the University of Lausanne (Switzerland).

Ruling out MI as a mediator between high heart rate and the development of heart failure means some other pathologic sequence is involved.

One possibility is that patients with high heart rates develop tachycardia-induced cardiomyopathy that progresses to heart failure, Dr. Nanchen said in an interview."

His study included 4,768 people aged 55 or older enrolled in the Rotterdam Study from among apparently healthy people living in the Rotterdam area. During a median follow-up of 15 years, 656 enrollees developed heart failure. The analysis excluded people who at baseline had heart failure, coronary heart disease, atrial fibrillation, atrioventricular block, or a pacemaker, or were taking a beta-blocker or calcium channel blocker.

Among the 1,829 men in the study; every increment of 10 beats per minute in resting heart rate at entry into the study was linked with a statistically significant, 16% relative increase in the incidence of heart failure, an association not seen in women. When the researchers divided the men into tertiles based on their baseline heart rate, those in the top tertile with a rate of 79 beats per minute or greater had a 51% increased incidence of heart failure during follow-up, compared with men in the lowest tertile, with a rate of less than 69 beats per minute.

The analysis adjusted for age, smoking status, systolic blood pressure, diabetes, body mass index, total cholesterol level, HDL cholesterol level, and antihypertensive treatment.

The absence of this heart rate and heart failure link in women was a "surprise," Dr. Nanchen said. It's possible that women's hearts are more resilient to high heart rates, he suggested.

For the time being, the only intervention to offer otherwise healthy men older than 55 with a high heart rate is intensified control of lifestyle risk factors. Trial results showed that treatment with the heart rate-lowering drug ivabradine (Prooralan) in heart failure patients led to a reduction in heart failure-related hospitalizations ( Lancet 2010;376: 875-85). That experience makes it attractive to speculate that ivabradine treatment might also improve outcomes in men with high heart rates and no heart failure, but Dr. Nanchen said he had no immediate plans to test that hypothesis.

U.S. physicians won't get the chance to study ivabradine in clinical practice for some time. Its manufacturer, Servier, has not disclosed any plans to submit a new drug application to the Food and Drug Administration.

Caption: Dr. Nanchen


Major finding: Among healthy men, heart rates of at least 79 beats per minute were linked with a 51% increased incidence of heart failure.

Data source: A prospective follow-up of a population-based cohort of 4,768 people enrolled in the Rotterdam Study.

Disclosures: Dr. Nanchen said he had no relevant financial disclosures. On Twitter @mitchelzoler


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Author:Zoler, Mitchel L.
Publication:Family Practice News
Date:May 15, 2013
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