Elevated heart rate and atherosclerosis: An overview of the pathogenetic mechanisms

Abstract Several epidemiological studies have reported that an elevated heart rate is associated with coronary atherosclerosis independently of other risk factors. In this review we explore the pathophysiologic mechanisms involved in the pro-atherosclerotic effect of elevated heart rate, apart from...

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Bibliographic Details
Published in:International journal of cardiology 2008-06, Vol.126 (3), p.302-312
Main Authors: Giannoglou, George D, Chatzizisis, Yiannis S, Zamboulis, Chrysanthos, Parcharidis, George E, Mikhailidis, Dimitri P, Louridas, George E
Format: Article
Language:English
Subjects:
Arterial stiffness
Atherosclerosis (general aspects, experimental research)
Biological and medical sciences
Blood and lymphatic vessels
Cardiology. Vascular system
Cardiovascular
Comorbidity
Coronary Artery Disease - epidemiology
Coronary Artery Disease - physiopathology
Coronary atherosclerosis
Coronary Circulation - physiology
Coronary heart disease
Heart
Heart rate
Heart Rate - physiology
Humans
Incidence
Male
Medical sciences
Prognosis
Pulsatile Flow - physiology
Pulsatile motion
Risk Assessment
Severity of Illness Index
Shear stress
Stress, Mechanical
Tachycardia - epidemiology
Tachycardia - physiopathology
Tensile stress
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Summary:Abstract Several epidemiological studies have reported that an elevated heart rate is associated with coronary atherosclerosis independently of other risk factors. In this review we explore the pathophysiologic mechanisms involved in the pro-atherosclerotic effect of elevated heart rate, apart from its association with sympathetic tone. An elevated heart rate enhances the magnitude and frequency of the tensile stress imposed on the arterial wall and prolongs the exposure of coronary endothelium to the systolic low and oscillatory shear stress. Moreover, increased heart rate intensifies the pulsatile motion of the heart and, therefore, the frequency of the periodically changing geometry of the coronary arteries, thereby affecting the local hemodynamic environment. All these processes induce structural and functional changes of the endothelial cells, which are accumulated over the time in atherosclerosis-prone regions promoting atherosclerosis. Heart rate should be considered in every patient with coronary heart disease, especially since it is an easily measurable and reproducible parameter. Slowing the heart rate could potentially decrease the progression of atherosclerosis by reducing the local pro-atherosclerotic vascular environment. This effect may be involved in any beneficial role of heart rate lowering agents in preventing coronary heart disease.
ISSN:0167-5273
1874-1754
DOI:10.1016/j.ijcard.2007.08.077