title: Heart rate is a prognostic risk factor for myocardial infarction: a post hoc analysis in the PERFORM (Prevention of cerebrovascular and cardiovascular Events of ischemic origin with teRutroban in patients with a history oF ischemic strOke or tRansient ischeMic attack) study population.
abstract: BACKGROUND
  Elevated resting heart rate is known to be detrimental to morbidity and mortality in cardiovascular disease, though its effect in patients with ischemic stroke is unclear. We analyzed the effect of baseline resting heart rate on myocardial infarction (MI) in patients with a recent noncardioembolic cerebral ischemic event participating in PERFORM.
  
  
  METHODS
  We compared fatal or nonfatal MI using adjusted Cox proportional hazards models for PERFORM patients with baseline heart rate <70 bpm (n=8178) or ≥70 bpm (n=10,802). In addition, heart rate was analyzed as a continuous variable. Other cerebrovascular and cardiovascular outcomes were also explored.
  
  
  RESULTS
  Heart rate ≥70 bpm was associated with increased relative risk for fatal or nonfatal MI (HR 1.32, 95% CI 1.03-1.69, P=0.029). For every 5-bpm increase in heart rate, there was an increase in relative risk for fatal and nonfatal MI (11.3%, P=0.0002). Heart rate ≥70 bpm was also associated with increased relative risk for a composite of fatal or nonfatal ischemic stroke, fatal or nonfatal MI, or other vascular death (excluding hemorrhagic death) (P<0001); vascular death (P<0001); all-cause mortality (P<0001); and fatal or nonfatal stroke (P=0.04). For every 5-bpm increase in heart rate, there were increases in relative risk for fatal or nonfatal ischemic stroke, fatal or nonfatal MI, or other vascular death (4.7%, P<0.0001), vascular death (11.0%, P<0.0001), all-cause mortality (8.0%, P<0.0001), and fatal and nonfatal stroke (2.4%, P=0.057).
  
  
  CONCLUSIONS
  Elevated heart rate ≥70 bpm places patients with a noncardioembolic cerebral ischemic event at increased risk for MI.
authors.affiliation: NHLI Imperial College, ICMS, Royal Brompton Hospital, London, UK. Electronic address: k.fox@rbht.nhs.uk.
authors.forename: Kim
authors.initials: K
authors.lastname: Fox
authors.forename: Marie-Germaine
authors.initials: MG
authors.lastname: Bousser
authors.forename: Pierre
authors.initials: P
authors.lastname: Amarenco
authors.forename: Angel
authors.initials: A
authors.lastname: Chamorro
authors.forename: Marc
authors.initials: M
authors.lastname: Fisher
authors.forename: Ian
authors.initials: I
authors.lastname: Ford
authors.forename: Michael G
authors.initials: MG
authors.lastname: Hennerici
authors.forename: Heinrich P
authors.initials: HP
authors.lastname: Mattle
authors.forename: Peter M
authors.initials: PM
authors.lastname: Rothwell
mesh_terms: D000368:Aged; D005260:Female; D006339:Heart Rate / Q000187:drug effects / Q000502:physiology*; D006801:Humans; D002546:Ischemic Attack, Transient / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D009281:Naphthalenes / Q000494:pharmacology / Q000627:therapeutic use*; D011379:Prognosis; D011422:Propionates / Q000494:pharmacology / Q000627:therapeutic use*; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology
chemical_list: D009281:Naphthalenes; D011422:Propionates; C501362:terutroban
keywords: Heart rate; Ischemic stroke; Myocardial infarction