thus reduction of heart rate may represent an important strategy for the treatment of patients

with a wide range of cardiac disorders. In addition, several experimental lines of research point

to high heart rate as an important risk factor for atherosclerosis and, thus, pharmacologic heart

rate reduction could prevent or retard the development of atherosclerotic plaques and increase

survival. Today, in patients with acute or chronic coronary syndromes or with congestive heart

failure, reducing heart rate is a generally accepted treatment modality. Up to now, no human

study has been performed to demonstrate the efficacy and the risk-benefit ratio of cardiac

slowing in patients without cardiac disorders. However, recent retrospective analyses of the

INternational VErapamil-SR/trandolapril STudy and the Paris Prospective Study 1 provided

promising results. Treatment of high heart rate in healthy subjects appears to be premature, but

in clinical conditions such as hypertension or diabetes, the reduction of elevated heart rate

appears a desirable additional goal of therapy. (Prog Cardiovasc Dis 2009;52:46-60)

© 2009 Elsevier Inc. All rights reserved.