this possibility, in the VALUE study, we evaluated the effect of baseline HR on incident HF occurring sepa- rately in each year of the trial (2). If tachycardia were a marker of subclinical congestive HF, a stronger asso- ciation would be expected in the early phases of the follow-up with an attenuation in later years. However, the association between high HR and incident HF was present throughout the trial and was significant even at the fifth year. To see whether this finding obtained in a hyper- tensive sample also holds true within a general pop- ulation, we encourage the MESA investigators to analyze the predictive power of baseline HR by using the same statistical procedure. *Paolo Palatini, MD Stevo Julius, MD *Dipartimento di Medicina University of Padova via Giustiniani 2 35128 Padua Italy E-mail: palatini@unipd.it http://dx.doi.org/10.1016/j.jacc.2014.04.049 REFERENCES 1. Opdahl A, Ambale Venkatesh B, Fernandes VR, et al. Resting heart rate as predictor for left ventricular dysfunction and heart failure: MESA (Multi-Ethnic Study of Atherosclerosis). J Am Coll Cardiol 2014;63:1182–9. 2. Julius S, Palatini P, Kjeldsen SE, et al. Usefulness of heart rate to predict cardiac events in treated patients with high-risk systemic hypertension. Am J Cardiol 2012;109:685–92. 3. Palatini P, Julius S. Heart rate and the cardiovascular risk. J Hypertens 1997; 15:3–17. REPLY: Resting Heart Rate: An Independent Predictor of Congestive Heart Failure We thank Drs. Palatini and Julius for their interest in our recent work (1). Indeed, in the MESA (Multi-Ethnic Study of Atherosclerosis) study, with participants without cardiovascular disease (CV) at enrollment, we found an increased risk for incident heart failure (HF) among those with elevated resting heart rate (HR). We appreciate that in the VALUE (Valsartan Antihy- pertensive Long-term Use Evaluation) trial extensive analyses of resting HR and incident HF were made in a large sample of hypertensive patients with high car- diovascular risk on antihypertensive treatment (2). Unfortunately, in-trial HR measurements were not a part of our study (1). We agree that a possible relationship between HR and coronary events may have been unrecognized in our study due to power issues. On the other hand, this does not prove the existence of such a relationship in a population without clinical CV diseases at enrollment, and alternative mechanisms may also contribute or coexist. Moreover, in our study, the resting HRs were somewhat lower than in the hypertensive patients in the VALUE trial, probably reflecting a healthier population. Using a statistical procedure similar to that in the VALUE trial, we evaluated the effect of baseline HR on HF events occurring separately for each 2-year interval of follow-up. In this post hoc analysis, a sig- nificant association was found between resting HR and HF events occurring during the first 2-year follow-up interval. In a multivariate Cox model, the hazard ratio (HR) for the highest baseline HR quartile (HR >70 beats/min) was 2.37 (95% confidence inter- val: 1.13 to 5.01) compared to the 3 lower quartiles (HR <70 beats/min). However, no significant associ- ations were found between HR and HF events occurring after the first 2 years. Thus, in contrast to the hypertensive sample in the VALUE study, in our study population without CV disease at baseline, one cannot exclude the possible relationship between latent left ventricular dysfunction and elevated HF. More studies of the relationship between resting HR and CV disease are certainly needed and we thank you for your valuable contributions to this field. Anders Opdahl, MD, PhD Bharath Ambale Venkatesh, PhD Veronica R.S. Fernandes, MD, PhD Colin O. Wu, PhD Khurram Nasir, MD Eui-Young Choi, MD, PhD Andre L.C. Almeida, MD Boaz Rosen, MD Benilton Carvalho, PhD Thor Edvardsen, MD, PhD David A. Bluemke, MD, PhD *João A.C. Lima, MD *Division of Cardiology, Blalock 524 Johns Hopkins University 600 North Wolfe Street Baltimore, Maryland 21287 E-mail: jlima@jhmi.edu http://dx.doi.org/10.1016/j.jacc.2014.05.017 REFERENCES 1. Opdahl A, Ambale Venkatesh B, Fernandes VR, et al. Resting heart rate as predictor for left ventricular dysfunction and heart failure: MESA (Multi-Ethnic Study of Atherosclerosis). J Am Coll Cardiol 2014;63:1182–9. 2. Julius S, Palatini P, Kjeldsen SE, et al. Usefulness of heart rate to predict cardiac events in treated patients with high-risk systemic hypertension. Am J Cardiol 2012;109:685–92. Letters JACC VOL. 64, NO. 4, 2014 JULY 29, 2014:420 – 2 422