ArticleBMC cardiovascular disorders2025
Suboptimal heart rate control despite beta-blocker use in coronary artery disease: evidence from the Fasa PERSIAN cohort.
Article in BMC cardiovascular disorders, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundElevated resting heart rate (HR ≥ 70 bpm) is a strong prognostic factor in coronary artery disease (CAD). Although beta-blockers are guideline-recommended first-line therapy, their real-world effectiveness in controlling HR remains unclear, particularly in Middle Eastern populations. This study investigated HR distribution, its correlates, and the association between HR-lowering drugs and HR control in a large Iranian cohort.
methodsWe analyzed 10,138 adults aged 35–70 years from the Fasa PERSIAN Cohort with sinus rhythm ECGs. HR was obtained from resting 12-lead ECGs. Logistic regression examined associations between demographic, clinical, and pharmacological factors and HR < 70 bpm. Multivariable models were further stratified by CAD and hypertension (HTN) subgroups.
resultsA total of 7119 subjects (mean age 48.6 ± 9.3 years; 43.4% men) entered this study, of which 803 (11.3%) had CAD. Overall, 48.6% had HR ≥ 70 bpm. Beta-blockers were used by 9.4% of participants (40% of CAD patients). Despite therapy, 47.2% of beta-blocker users had HR ≥ 70 bpm. In univariable analysis, male sex (OR 4.07, 95% CI 3.68–4.50), current smoking (OR = 2.59,95%CI:2.28–2.93), and higher physical activity were strong predictors of HR < 70 bpm, while diabetes, hypertension, and higher BMI were inversely associated. In multivariable analysis, beta-blocker use was associated with HR < 70 bpm in the total population (OR 1.64, 95% CI 1.36–1.98) and in HTN patients (OR = 2.35,95%CI:1.72–3.22), but not in CAD or CAD + HTN subgroups.
conclusionNearly half of CAD patients failed to achieve HR < 70 bpm despite beta-blocker therapy, highlighting suboptimal control. Beta-blockers were effective only in patients with HTN but not in CAD or CAD + HTN groups. These findings emphasize the need for tailored therapeutic strategies and physician education to improve HR management in CAD.
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