Numerosos estudios epidemiológicos han demostrado que hay relación entre el aumento de la frecuencia cardiaca y el incremento de la mortalidad total y cardiovascular tras ajustar por otros factores de riesgo cardiovascular. La mayoría de los estudios ha analizado poblaciones generales, mientras que sólo unos pocos han considerado poblaciones de pacientes hipertensos o con enfermedad coronaria estable. Esta relación entre aumento de la frecuencia cardiaca y morbimortalidad es más evidente en los varones que en las mujeres.
Aunque el aumento de la frecuencia cardiaca puede ser un marcador de alguna enfermedad subyacente, lo que podría explicar la asociación con incremento de la mortalidad, lo cierto es que ésta no parece ser la causa. Hay evidencias de que el aumento de la frecuencia cardiaca se asocia con aumento de la actividad del sistema simpático, con aumento de la presión arterial, con obesidad y síndrome metabólico y con progresión de la aterosclerosis. De igual forma, se ha observado asociación entre el incremento de la frecuencia cardiaca y la rotura de la placa aterosclerótica coronaria.
Dada esta información, parece razonable que los clínicos comencemos a valorar la importancia de la frecuencia cardiaca como un factor de riesgo independiente. Futuros estudios nos indicarán si la reducción selectiva de la frecuencia cardiaca mejora el pronóstico de los pacientes con frecuencia cardiaca elevada.
Palabras clave
Frecuencia cardiaca
Factores de riesgo
Epidemiología
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