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Abstract Background A new definition of metabolically healthy obesity (MHO) has recently been proposed to stratify the heterogeneous mortality risk of obesity. Metabolomic profiling provides clues to metabolic alterations beyond clinical definition. We aimed to evaluate the association between MHO and cardiovascular events and assess its metabolomic pattern. Methods This prospective study included Europeans from two population-based studies, the FLEMENGHO and the Hortega study. A total of 2339 participants with follow-up were analyzed, including 2218 with metabolomic profiling. Metabolic health was developed from the third National Health and Nutrition Examination Survey and the UK biobank cohorts and defined as systolic blood pressure

Introducción: La hipertensión arterial es un problema de salud pública global, agudizado por el impacto de la pandemia por COVID-19, el cual ha generado importantes esfuerzos a escala mundial y nacional para fortalecer la prevención, la detección temprana y la terapia oportuna y así mitigar sus repercusiones multidimensionales. Objetivo: Unificar criterios y generar recomendaciones clínicas basadas en la evidencia para el diagnóstico y tratamiento de pacientes con hipertensión arterial. Método: Se realizó un consenso intersocietario con la participación de varias asociaciones colombianas para la adaptación y/o adopción de recomendaciones clínicas informadas en evidencia que orientan el diagnóstico y tratamiento del paciente adulto (mayor o igual a 18 años) con hipertensión arterial. Resultados: Se obtuvo respuesta de diecinueve expertos. El rango de acuerdo para las recomendaciones incluidas en el consenso osciló entre 84.2 y 100%. Se generaron veintidós recomendaciones clínicas para las dimensiones de diagnóstico (n = 6), tratamiento no farmacológico (n = 6) y tratamiento farmacológico (n = 10). Conclusiones: Las recomendaciones clínicas de este consenso orientan la toma de decisiones clínicas interdisciplinarias respecto al diagnóstico y tratamiento de personas con hipertensión arterial.

Resumo Fundamento A oncostatina M (OSM) é uma citocina pleiotrópica que, após lesão arterial, demonstra ser expressa rapidamente. Objetivos Correlacionar os níveis séricos da OSM, do receptor solúvel de oncostatina M (sOSMR) e da fração solúvel de glicoproteína 130 (sgp130) em pacientes com doença arterial coronariana (DAC) a parâmetros clínicos. Métodos Os níveis de sOSMR e sgp130 foram avaliados por ELISA, enquanto os de OSM foram avaliados por Western Blot, em pacientes com SCC (n=100), pacientes com SCA (n=70) e 64 voluntários do grupo de controle sem manifestações clínicas da doença. Valores de p

Abstract Aims Cardiac allograft vasculopathy (CAV) is the major long‐term complication after heart transplantation, leading to mortality and re‐transplantation. As available non‐invasive biomarkers are scarce for CAV screening, we aimed to identify a proteomic signature for CAV. Methods and results We measured urinary proteome by capillary electrophoresis coupled with mass spectrometry in 217 heart transplantation recipients (mean age: 55.0 ± 14.4 years; women: 23.5%), including 76 (35.0%) patients with CAV diagnosed by coronary angiography. We randomly and evenly grouped participants into the derivation cohort (n = 108, mean age: 56.4 ± 13.8 years; women: 22.2%; CAV: n = 38) and the validation cohort (n = 109, mean age: 56.4 ± 13.8 years; women: 24.8%, CAV: n = 38), stratified by CAV. Using the decision tree‐based machine learning methods (extreme gradient boost), we constructed a proteomic signature for CAV discrimination in the derivation cohort and verified its performance in the validation cohort. The proteomic signature that consisted of 27 peptides yielded areas under the curve of 0.83 [95% confidence interval (CI): 0.75–0.91, P

Background Hypertension and diabetes cause chronic kidney disease (CKD) and diastolic left ventricular dysfunction (DVD) as forerunners of disability and death. Home blood pressure telemonitoring (HTM) and urinary peptidomic profiling (UPP) are technologies enabling prevention. Methods UPRIGHT-HTM (Urinary Proteomics Combined with Home Blood Pressure Telemonitoring for Health Care Reform [NCT04299529]) is an investigator-initiated 5-year clinical trial with patient-centred design, which will randomise 1148 patients to be recruited in Europe, sub-Saharan Africa and South America. During the whole study, HTM data will be collected and freely accessible for patients and caregivers. The UPP, measured at enrolment only, will be communicated early during follow-up to 50% of patients and their caregivers (intervention), but only at trial closure in 50% (control). The hypothesis is that early knowledge of the UPP risk profile will lead to more rigorous risk factor management and result in benefit. Eligible patients, aged 55–75 years old, are asymptomatic, but have ≥5 CKD- or DVD-related risk factors, preferably including hypertension, type-2 diabetes, or both. The primary endpoint is a composite of new-onset intermediate and hard cardiovascular and renal outcomes. Demonstrating that combining UPP with HTM is feasible in a multicultural context and defining the molecular signatures of early CKD and DVD are secondary endpoints. Expected outcomes The expected outcome is that application of UPP on top of HTM will be superior to HTM alone in the prevention of CKD and DVD and associated complications and that UPP allows shifting emphasis from treating to preventing disease, thereby empowering patients.

BackgroundSystemic hypoperfusion plays a pivotal role in the pathogenesis of primary open-angle glaucoma (POAG). Extreme dips in mean arterial pressure (MAP) due to high 24-h variability are associated with POAG, however, whether this is driven by diurnal or nocturnal dips remains undocumented. We aimed this study to investigate the association of POAG damage with variability and dips in the diurnal and nocturnal MAP.MethodsWe conducted a retrospective longitudinal study that included 110 POAG patients who underwent 24-h ambulatory blood pressure monitoring. Our outcomes included (i) functional [visual field defects expressed as mean deviation (MD)] and (ii) structural (optic disc cupping obtained from cup-to-disc ratio) glaucoma damage. MAP variability independent of the mean (VIMmap) was computed for diurnal and nocturnal MAP. Dips were the five diurnal and three nocturnal lowest drops in MAP. We also calculated the night-to-day ratio. We applied mixed models to evaluate the progression of visual field defects and optic disc cupping in relation to diurnal and nocturnal MAP measures.ResultsThe mean age was 64.0 y (53% women). The median follow-up was 9 years. In adjusted mixed models, functional progression of glaucoma damage was associated with VIMmap (−2.57 dB change in MD per every 3 mmHg increase in VIMmap; P < 0.001) and diurnal MAP dips (changes in the MD ranged from −2.56 to −3.19 dB; P < 0.001). Every 5 mmHg decrease in the nocturnal MAP level was associated with −1.14 dB changes in MD [95% confidence interval (CI), −1.90 to −0.40] and 0.01 larger optic disc cupping (95% CI, 0.01–0.02). Lower night-to-day ratio was also related to both outcomes (P ≤ 0.012). Functional glaucoma damage worsened if nocturnal hypotension was combined with high variability or extreme dips in the diurnal MAP (P ≤ 0.022).ConclusionProgression of glaucoma damage in POAG associates with high variability and extreme dips in the diurnal MAP. Structural glaucoma damage seems more vulnerable to nocturnal hypotension. Ambulatory blood pressure monitoring allows the assessment of sporadic diurnal and persistent nocturnal hypotension episodes. These phenotypes might offer an opportunity to improve the risk-stratification of open-angle glaucoma (OAG).

BackgroundVascular calcification is strongly related to the risk of mortality and cardiovascular (CV) diseases. In vascular calcification, matrix Gla protein (MGP), a small vitamin K-dependent protein, is an important mineralization inhibitor. Recent studies showed that circulating MGP is associated with mortality risk. However, the longitudinal association between urinary excretion of MGP and all-cause mortality was not established.Materials and methodsUrinary MGP was measured in 776 randomly recruited Flemish population (mean age: 51.2 years; 50.9% women) at baseline (during 2005–2010) using capillary electrophoresis coupled with mass spectrometry. Plasma inactive MGP [desphospho-uncarboxylated MGP (dp-ucMGP)] levels were quantified in 646 individuals by ELISA kits. Mortality status was ascertained through the Belgian Population Registry until 2016. The longitudinal association with mortality was determined by the multivariate-adjusted Cox proportional hazards regression models. The multivariate linear regression models were used to identify determinants of urinary MGP level.ResultsOver the 9.2 years, 47 (6.06%) participants died, including 15 CV deaths. For a doubling of urinary MGP, the hazard ratios (HRs) were 1.31 (95% CI: 1.01–1.69, P = 0.040) for all-cause mortality and 2.05 (95% CI: 1.11–3.79, P = 0.023) for CV mortality with adjustment for covariates, including estimated glomerular filtration rate and urine microalbumin. The addition of urinary MGP to the basic models improved the reclassification as suggested by the increased net reclassification improvement [64.01% (95% CI: 32.64–98.63)] and integrated discrimination improvement [2.33% (95% CI: 0.24–4.71)]. Circulating inactive MGP, total cholesterol, urine microalbumin, and smoking were significantly associated with urinary MGP levels (P ≤ 0.041), independent of sex and age.ConclusionElevated urinary MGP was associated with an increased risk of all-cause mortality and CV mortality and improved the risk reclassification for all-cause mortality. These findings suggested that urinary MGP might be useful in mortality risk assessment in the general population. However, these observations need to be replicated in larger studies with a longer follow-up time.

Background The underlying mechanisms of arterial stiffness remain not fully understood. This study aimed to identify a urinary proteomic profile to illuminate its pathogenesis and to determine the prognostic value of the profile for adverse outcomes. Methods and Results We measured aortic stiffness using pulse wave velocity (PWV) and analyzed urinary proteome using capillary electrophoresis coupled with mass spectrometry in 669 randomly recruited Flemish patients (mean age, 50.2 years; 51.1% women). We developed a PWV‐derived urinary proteomic score (PWV‐UP) by modeling PWV with proteomics data at baseline through orthogonal projections to latent structures. PWV‐UP that consisted of 2336 peptides explained the 65% variance of PWV, higher than 36% explained by clinical risk factors. PWV‐UP was significantly associated with PWV (adjusted β=0.73 [95% CI, 0.67–0.79]; P

Objetivo: Determinar el tratamiento inicial y la mortalidad intrahospitalaria de pacientes con síndrome coronario agudo que acudieron a centros hospitalarios de referencia de Paraguay. Método: Estudio observacional y multicéntrico en pacientes mayores de 18 años con diagnóstico confirmado de síndrome coronario agudo. Resultados: Se incluyó a 780 pacientes desde mayo de 2015 hasta febrero de 2016; la edad media fue de 64.1 ± 12.3 años y el género masculino representó el 64.1%. La presentación clínica fue la de síndrome coronario agudo con elevación del ST en 40.1% y sin elevación del ST en 59.9%. En pacientes con elevación del ST se observó un alto porcentaje de consultas tardías, mayor de 12 h de evolución en 49.8%; en aquéllos con menos de 12 h de evolución se indicó la reperfusión en 52.2%, el 36.3% recibió fibrinolíticos y 15.9% intervención coronaria percutánea primaria. La mortalidad hospitalaria del síndrome coronario agudo fue de 10.3%, con elevación del segmento ST en 12.8% y sin elevación del segmento ST en 8.6%. Conclusiones: El tratamiento del síndrome coronario agudo en el Paraguay requiere un abordaje integral, que promueva consultas más tempranas y aumente la institución de tratamientos de reperfusión en la red de servicios de salud; el objetivo es mejorar los índices de respuesta terapéutica y disminuir la mortalidad hospitalaria.

Background Prematurity disrupts the perinatal maturation of the microvasculature and macrovasculature and confers high risk of vascular dysfunction later in life. No previous studies have investigated the crosstalk between the microvasculature and macrovasculature in childhood. Methods and Results In a case‐control study, we enrolled 55 children aged 11 years weighing

Resumen: De manera paralela, a raíz de la nueva evidencia científica que respalda el tratamiento intensivo de la hipertensión arterial, en 2017 el Colegio Americano de Cardiología (ACC) y la Asociación Americana del Corazón (AHA) establecieron nuevas directrices para la prevención, detección, evaluación y manejo de la hipertensión arterial en adultos.La recomendación formal fue utilizar menores umbrales de presión arterial para el inicio del tratamiento antihipertensivo. Esta consideración se derivó de la existencia de estudios que asociaban el logro de cifras menores de presión arterial con la disminución significativa en el riesgo de enfermedad cardiovascular y de la mortalidad en la población hipertensa.A la luz de esta nueva definición de hipertensión arterial, Muntner et al. consideran que su prevalencia en los Estados Unidos sería 45,6%, comparado con el 31,9%, si se usaran los parámetros previamente aceptados e implementados desde el JNC7, comité en el que el porcentaje de adultos estadounidenses recomendados para tratamiento antihipertensivo pasaría de 34,3% a 36,2%, en tanto que el porcentaje de hipertensos que no logran las metas establecidas se incrementaría de 39 a 53,4%.Por su parte, Bundy et al. llegaron a conclusiones similares, calculando que 45,4% de los adultos estadounidenses (105.3 millones) mayores de 20 años tendrían hipertensión según la nueva clasificación, comparado con los datos del año 2014, que consideraban como hipertensos al 32,0% (74.1 millones). Esta diferencia de 13,5% equivale a 31.3 millones de personas que serían clasificadas como hipertensas.En Colombia, la aplicación de la nueva clasificación supondría pasar de una prevalencia de 22,0% en 2016 a un valor estimado del 43,3% en la actualidad, tan solo por variar la cifra de corte para ser considerado hipertenso, lo cual es equivalente a catalogar como enfermos a aproximadamente 21 millones de personas. Abstract: In 2017, the American College of Cardiology (ACC) and the American Heart Association (AHA) concurrently established new guidelines for the prevention, detection, assessment and management of arterial hypertension in adults, based on new scientific evidence supporting its intensive treatment.The formal recommendation was to use lower arterial pressure thresholds for initiating antihypertensive treatment. This consideration arose from studies which related the achievement of lower arterial pressure figures with a significant decrease in the risk of cardiovascular disease and mortality in the hypertensive population.In light of this new definition of arterial hypertension, Muntner et al. consider that the prevalence of hypertension in the United States would be 45.6%, compared with 31.9% if the previously accepted and implemented parameters from the JNC7 were applied. According to this committee, the percentage of American adults recommended for antihypertensive treatment would go from 34.3% to 36.2%, while the percentage of hypertensives not achieving the established goals would increase from 39 to 53.4%.Meanwhile, Bundy et al. reached similar conclusions, calculating that 45.4% of adult Americans over the age of 20 (105.3 million) would have hypertension according to the new classification, compared to data from 2014, which considered 32.0% (74.1 million) to be hypertensive. This 13.5% difference amounts to 31.3 million people who would be classified as hypertensive.In Colombia, the application of the new classification would mean going from a prevalence of 22.0% in 2016 to an estimated 43.3%, currently, just by changing the cut-off value for being considered hypertensive, which would amount to classifying approximately 21 million people as sick. Palabras clave: Hipertensión arterial, Consenso, Enfermedad cardiovascular, Keywords: Arterial hypertension, Consensus, Cardiovascular disease

BackgroundAlthough 24‐hour blood pressure (BP) variability (BPV) is predictive of cardiovascular outcomes independent of absolute BP levels, it is not regularly assessed in clinical practice. One possible limitation to routine BPV assessment is the lack of standardized methods for accurately estimating 24‐hour BPV. We conducted a systematic review to assess the predictive power of reported BPV indexes to address appropriate quantification of 24‐hour BPV, including the average real variability (ARV) index. Methods and ResultsStudies chosen for review were those that presented data for 24‐hour BPV in adults from meta‐analysis, longitudinal or cross‐sectional design, and examined BPV in terms of the following issues: (1) methods used to calculate and evaluate ARV; (2) assessment of 24‐hour BPV determined using noninvasive ambulatory BP monitoring; (3) multivariate analysis adjusted for covariates, including some measure of BP; (4) association of 24‐hour BPV with subclinical organ damage; and (5) the predictive value of 24‐hour BPV on target organ damage and rate of cardiovascular events. Of the 19 assessed studies, 17 reported significant associations between high ARV and the presence and progression of subclinical organ damage, as well as the incidence of hard end points, such as cardiovascular events. In all these cases, ARV remained a significant independent predictor (P

La neuropatía autonómica diabética cardiovascular es un trastorno en el cual una alteración en la regulación del sistema nervioso cardiovascular, por parte del sistema nervioso autónomo, desemboca en una constelación de síntomas, que pueden ir desde intolerancia al ejercicio hasta muerte súbita. Si bien no se conoce su prevalencia exacta, se estima que es alta en pacientes diabéticos, particularmente en aquellos con diabetes de larga data y con presencia de otras comorbilidades. Su reconocimiento temprano puede facilitar el manejo de estos pacientes y a su vez disminuir los costos asociados a pruebas e intervenciones innecesarias con el objetivo de evitar complicaciones asociadas con la enfermedad.

La neuropatía autonómica diabética cardiovascular es un trastorno en el cual una alteración en la regulación del sistema nervioso cardiovascular, por parte del sistema nervioso autónomo, desemboca en una constelación de síntomas, que pueden ir desde intolerancia al ejercicio hasta muerte súbita. Si bien no se conoce su prevalencia exacta, se estima que es alta en pacientes diabéticos, particularmente en aquellos con diabetes de larga data y con presencia de otras comorbilidades. Su reconocimiento temprano puede facilitar el manejo de estos pacientes y a su vez disminuir los costos asociados a pruebas e intervenciones innecesarias con el objetivo de evitar complicaciones asociadas con la enfermedad.

Introducción y objetivos: la incorporación de las nuevas guías de actuación de la Sociedad Europea de Cardiología en el síndrome coronario agudo, con coronariografía precoz (24 horas) tras trombólisis, incluso si es efectiva y sin necesidad de demostrar signos de isquemia residual, en los casos en los que no se realiza angioplastia primaria, ha supuesto un reto respecto a la forma tradicional de actuar en los Servicios de Cardiología. Métodos: durante 2007, 2008 y la primera mitad de 2009 se atendieron 266 pacientes con infarto agudo del miocardio con ST elevado tratados con trombólisis. De ellos, y tras excluir los rescates (41), en 94 (42%) se realizó cateterismo dentro de las primeras 24 horas (angiografía del día siguiente) y en los 131 (58%) restantes se siguió una estrategia convencional con test de provocación de isquemia (tratamiento convencional). Resultados: en el primer grupo, la estancia media fue de 7,3 ± 3 días [mediana, rango intercuantílico: 7 (5-8)]. La incidencia de eventos mortales al año fue de 3 (4%). No hubo ningún sangrado mayor; sólo 20 de ellos (22%) presentaron hematomas inguinales mayores de 2 cm. En el segundo, la estancia media fue de 10,2 ± 6,3 días [9 (6-13)], significativamente mayor (pIntroduction and objectives: The introduction of new practice guidelines of the European Society of Cardiology in acute coronary syndrome with early coronary angiography (24 hours) after thrombolysis, even if it is effective without showing signs of residual ischemia in the cases where primary angioplasty is not performed, has been a challenge over the traditional approach in the Departments of Cardiology. Methods: During 2007, 2008 and the first half of 2009, 266 patients with acute myocardial infarction with ST segment elevation were treated with thrombolysis. After excluding the bailouts (41), in 94 (42%) of them, a catheterization was peformed within the first 24 hours (next day angiography) and the remaining 131 (58%) underwent a conventional strategy with a provocation test to elicit ischemia (conventional treatment). Results: In the first group, the average stay was 7.3 ± 3 days [median interquartile range: 7 (5-8)]. The incidence of fatal events per year was 3 (4%). There were no major bleeding, only 20 of them (22%) had groin hematomas larger than 2 cm. In the second group, the average stay was 10.2 ± 6.3 days [9 (6-13)], significantly higher (p

la incorporación de las nuevas guías de actuación de la Sociedad Europea de Cardiología en el síndrome coronario agudo, con coronariografía precoz (24 horas) tras trombólisis, incluso si es efectiva y sin necesidad de demostrar signos de isquemia residual, en los casos en los que no se realiza angioplastia primaria, ha supuesto un reto respecto a la forma tradicional de actuar en los Servicios de Cardiología. Métodos: durante 2007, 2008 y la primera mitad de 2009 se atendieron 266 pacientes con infarto agudo del miocardio con ST elevado tratados con trombólisis. De ellos, y tras excluir los rescates (41), en 94 (42%) se realizó cateterismo dentro de las primeras 24 horas (angiografía del día siguiente) y en los 131 (58%) restantes se siguió una estrategia convencional con test de provocación de isquemia (tratamiento convencional). Resultados: en el primer grupo, la estancia media fue de 7,3 ± 3 días [mediana, rango intercuantílico: 7 (5-8)]. La incidencia de eventos mortales al año fue de 3 (4%). No hubo ningún sangrado mayor; sólo 20 de ellos (22%) presentaron hematomas inguinales mayores de 2 cm. En el segundo, la estancia media fue de 10,2 ± 6,3 días [9 (6-13)], significativamente mayor (p

A 65-year-old woman presented with a history of dyspnea and atypical chest pain. She was diagnosed with a non-ST-segment elevation myocardial infarction due to a giant right coronary artery aneurysm. After a failed percutaneous embolization, she was scheduled for right coronary artery aneurysm resection, posterior descending artery revascularization and mitral valve repair. During the induction of anesthesia and institution of mechanical ventilation, the patient suffered cardiovascular collapse. The transesophageal echocardiographic examination revealed tamponade physiology owing to compression of the cardiac chambers by the unruptured aneurysm, which resolved with the sternotomy. The surgery was carried out uneventfully.

El síncope asociado con el ejercicio es una condición que debe alertar al médico tratante; en primera instancia, se descartan alteraciones estructurales cardiacas que predispongan a muerte súbita, y en segundo lugar se evalúa la presencia de arritmias que potencialmente causen esta condición. En pacientes mayores de 35 años se descartan la enfermedad coronaria y las valvulopatías como eventuales causas. En sujetos que entrenan de manera frecuente, el tono vagal aumentado es una condición adaptativa común que a veces puede causar síncope cardioinhibitorio asociado con el ejercicio, cuya presentación puede variar desde bradiarritmias hasta asistolia, por lo cual constituye un reto diagnóstico.Exercise-induced syncope is a condition that should alert the treating physician; structural cardiac abnormalities that predispose to sudden death should be discarded, and the presence of arrhythmias that may potentially cause this condition are evaluated. In patients over 35 years, coronary and valvular disease are ruled-out as a possible cause of syncope associated with exercise. In subjects who train frequently, increased vagal tone is a common adaptive condition that may sometimes cause cardio-inhibitory syncope associated with exercise, whose presentation may vary from bradyarrhythmia to asystolia, thereby providing a diagnostic challenge.

El síncope asociado con el ejercicio es una condición que debe alertar al médico tratante; en primera instancia, se descartan alteraciones estructurales cardiacas que predispongan a muerte súbita, y en segundo lugar se evalúa la presencia de arritmias que potencialmente causen esta condición. En pacientes mayores de 35 años se descartan la enfermedad coronaria y las valvulopatías como eventuales causas. En sujetos que entrenan de manera frecuente, el tono vagal aumentado es una condición adaptativa común que a veces puede causar síncope cardioinhibitorio asociado con el ejercicio, cuya presentación puede variar desde bradiarritmias hasta asistolia, por lo cual constituye un reto diagnóstico.

Desde hace mucho tiempo se sabe que en las diferentes escalas zoológicas la frecuencia cardiaca es un factor que determina la esperanza de vida en años. En la especie humana parece suceder algo similar. En un reciente estudio (BEAUTIFUL), en enfermos con falla cardiaca y enfermedad coronaria, los pacientes con una frecuencia cardiaca > 70 lpm obtuvieron un beneficio significativo en eventos coronarios, hospitalización por infarto del miocardio y revascularización coronaria, al reducirla con un nuevo medicamento que actúa exclusivamente en la corriente If del nodo sinusal, reduciéndola sin componente hemodinámico asociado (esto es, no efecto inotrópico negativo). La enfermedad isquémica cardiaca se ha visto como un disbalance entre la oferta y la demanda de oxígeno en el miocardio. Por tal motivo, los medicamentos que disminuyen su consumo (betabloqueadores y algunos calcioantagonistas), a través del efecto inotrópico negativo, se han convertido en el pilar fundamental para el manejo de este proceso. Sin embargo, el efecto betabloqueador tiene un sobrecosto el cual es el efecto vasoconstrictor mediado por el efecto alfa que se libera al bloquear los receptores beta. De ahí que los betabloqueadores con efecto vasodilatador -carvedilol, nebivolol- no tengan esta desventaja. Recientemente, surgió una nueva clase terapéutica que puede coadyuvar en el manejo de enfermos coronarios, al disminuir de manera selectiva la frecuencia cardiaca y prolongar el tiempo de llenado diastólico, mejorando la perfusión miocárdica sobre todo en la zona más vulnerable: el sub-endocardio. El primer medicamento de esta clase es la ivabradina. Se hace una revisión sobre el papel de la frecuencia cardiaca en el sistema cardiovascular, la corriente If, la fisiología de la enfermedad isquémica cardiaca y los beneficios de la ivabradina al disminuir exclusivamente la frecuencia cardiaca con su impacto adicional sobre la pared vascular y más específicamente en la hemodinámica de la placa aterosclerótica.We have known for many years that in the different zoological scales the heart rate is a determinant of life expectancy in years. It seems that something similar occurs in the human species. In a recent study (BEAUTIFUL), performed in patients with heart failure and coronary heart disease, patients with heart rate higher or equal to 70 beats per minute had a significant benefit in coronary events, hospitalization for cardiac infarct and coronary revascularization, by reducing it with a new drug that acts exclusively in the sinus node If current, without any hemodynamic associated component (this is, no inotropic negative effect). Ischemic heart disease has been seen as an imbalance between oxygen supply and demand in the myocardium. Therefore, medications that decrease its consumption (betablockers and some calcium antagonists) have become the mainstay for the management of this process, due to its negative inotropic effect. Nevertheless, betablocker effect has an extra cost that is the vasoconstrictor effect, mediated by the alfa effect that is liberated when blocking the beta receptors. For that reason, betablockers with vasodilator effect-carvediol, nebivolol- do not have this disadvantage. Recently, a new therapeutic class that may help in coronary patients management emerged, by selectively decreasing the heart rate and prolonging diastolic filling time, improving myocardial perfusion especially in the most vulnerable zone: the subendocardium. The first specific heart rate-lowering agent is ivabradine. A review of the heart rate role on the cardiovascular system, the If current, ischemic heart disease physiology, and ivabradine benefits when exclusively decreasing the heart rate with its additional impact on the vascular wall and more specifically in the atheroesclerotic plaque hemodynamics, is made.