Coronary Artery Disease (CAD) develops when certain factors damage the inner layers of the coronary arteries. Key risk factors which have been identified in patients with CAD includes:

Conventional risk factors:

  • Age
  • Family history of early heart disease
  • Smoking
  • High blood pressure
  • High amount of cholesterol
  • Physical inactivity
  • Obesity
  • Insulin resistance or diabetes

Emerging risk factor: Elevated resting heart rate.

Heart rate and CAD
A large body of evidence from epidemiological studies and clinical trials has shown that elevated resting heart rate is associated with a significantly increased risk of heart attack and death in patients with CAD.11 Heart rate is a major determinant of oxygen consumption and can precipitate most episodes of ischemia, both symptomatic and silent. One key study found that CAD patients with a high resting heart rate (≥70 beats per minute) were at 46% greater risk of heart attack and 34% more likely to die from cardiovascular causes.12 Because of this emerging role as a risk factor for CAD, resting heart rate is becoming an important consideration for clinicians when choosing optimal therapy for CAD patients.6 Lowering the resting heart rate in patients with CAD reduces the heart’s oxygen requirements and may have beneficial effects in terms of reducing cardiovascular events.


6. The CLARIFY Registry: Management of Stable Coronary Artery Disease in Clinical Practice. Brochure for participating doctors. Edited by G Steg on behalf of the BEAUTIFUL Executive Committee.
7. Jones DW, Chambless LE, Folsom AR, Heiss G, Hutchinson RG, Sharrett AR, Szklo M, Taylor HA Jr. Risk factors for coronary heart disease in African Americans: the Atherosclerotic Risk in Communities Study, 1987–1997. Arch Intern Med. 2002;162:2565–2571.
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9. MedlinePlus. Coronary Artery Disease. Available at:
10. National Heart Lung and Blood Institute. Coronary Artery Disease. Available at:
11. Fox K, Borer JS, Camm AJ, et al. Resting heart rate in cardiovascular disease. J Am Coll Cardiol. 2007; 50:823–830.
12. Fox K, Ford I, Steg PG et al. Heart rate as a prognostic risk factor in patients with coronary artery disease and left-ventricular systolic dysfunction (BEAUTIFUL): a subgroup analysis of a randomised controlled trial. Lancet. 2008; 6; 817–821.