Heart rate is a potent predictor of major cardiovascular events in the general population and in patients with cardiovascular disease. High heart rate facilitates atherogenesis and atherosclerosis progression. It is an important determinant of the occurrence of myocardial ischemia and malignant arrhythmias. Despite its associations with other risk factors, it remains an independent risk predictor in epidemiological studies. Heart rate reduction is associated with clinical benefits in the treatment of coronary artery disease and heart failure. Promoting heart rate from a risk predictor with important prognostic implications to a risk factor will require formal demonstration that pure heart rate reduction will decrease cardiovascular event rates in a prospectively conducted clinical trial. This hypothesis is currently being tested in the BEAUTIFUL and SHIFT trials...