marker of risk or even a risk factor for cardiovascular morbidity and mortality. This article

reviews current evidences concerning the relation between heart rate and patients' outcome in

different clinical settings such as acute coronary syndromes, left ventricular systolic

dysfunction, and heart failure. The relationship between resting heart rate and the development

of coronary artery disease, as well as all-cause and cardiovascular mortality, has been found to

be strong, graded, and independent from other risk factors. Several lines of research indicate

that heart rate plays an important role in the pathophysiology of atherosclerosis and in the

clinical manifestations of coronary artery disease and that it is an independent prognostic factor

in all coronary syndromes. The prognostic value of elevated heart rate in patients with heart

of the effects of these drugs. In the BEAUTIFUL trial, a subgroup analysis conducted in

patients with resting HR more than 70 beats per minute showed that treatment with ivabradine

was able to improve outcome. According to the results presented in this review, we can

conclude that heart rate is a predictor of death in both stable coronary artery disease and acute

coronary syndromes. Elevated heart rate is also able to negatively predict clinical outcomes in

patients with heart failure. However, it is still unclear if heart rate reduction per se can improve

prognosis. (Prog Cardiovasc Dis 2009;52:38-45)