Reduced resting heart rate linked to lower incidence of CV events in CAD
Reduction of resting heart rate (RHR) with the beta-blocker (β-blocker) bisoprolol was associated with a decreased incidence of composite cardiovascular (CV) events in Chinese patients with coronary artery disease (CAD) according to a study presented at the Asian Pacific Society of Cardiology Congress (APSC 2017) held in Singapore.
“Elevated RHR is an important risk factor of CAD,” according to lead author Professor Yundai Chen from the Department of Cardiology at the Chinese People's Liberation Army General Hospital in Beijing, China, citing a previous study showing the detrimental CV effects of a relatively high RHR. [J Am Coll Cardiol 2007;50:823-830]
This phase IV, observational study enrolled 663 patients (mean age 63 years, 73.6 percent male) in the intent-to-treat (ITT) group, 94.7 percent of whom had a history of ≥1 disease related to CAD. Five hundred and thirteen CAD patients were included in the efficacy analysis (EA) group. The primary outcome was a composite of CV death, nonfatal acute myocardial infarction, and hospitalization due to unstable angina or revascularization in patients with CAD within 18 months after starting bisoprolol treatment. [APSC 2017, abstract P211]
Compared with an RHR of 69–74 beats per minute (bpm), patients with an RHR of <65 bpm had a significantly lower risk of composite CV events in the ITT (18 vs six events) and EA groups (17 vs five events).
In a subgroup analysis, patients with continuous average RHR showed no significant effect on the incidence of composite CV events, but a significant effect was observed in patients with no history of diabetes (p=0.0345) and aged ≥70 years (p=0.0106) in the EA group.
In addition, patients with an RHR of 69–74 bpm had a significant effect on hospital admission for acute coronary syndrome (hazard ratio [HR], 3.004; p=0.0196 for ITT group and HR, 3.526; p=0.0132 for EA group).
A significant reduction in RHR was noted at 6 months (68.63 and 68.65 bpm), 12 months (68.71 and 68.49), and 18 months of follow-up (67.92 and 67.89 bpm) compared with RHR at baseline (75.47 and 75.28 bpm) in the ITT and EA groups, respectively.
Despite previous studies showing a high percentage of inadequately controlled RHR in CAD patients treated with β-blocker therapy, the available evidence validates the beneficial effects of β-blockers in patients with CAD, said Chen.
Among all participants, 22 percent reported ≥1 adverse event (AE), whereas 11.9 percent had serious AEs and 1.1 percent had drug-related AEs.Overall, the results showed an acceptable safety and tolerability profile of bisoprolol in patients with CAD, he added.