Assessment of resting heart rate is frequently performed and is easy, reliable and inexpensive. Heart rate is used in many algorithms to assess the prognosis of acutely ill patients. Elevated resting heart rate is independently related to the development of type 2 diabetes, cardiovascular disease and premature all-cause mortality. Adding heart rate to cardiovascular prediction models does not lead to improved prediction of vascular events or mortality. Beta blockers and non-dihydropyridine calcium channel blockers decrease heart rate (and blood pressure) and lower the risk of premature mortality in patients with heart failure or recent myocardial infarction. In two recent randomised trials, ivabradine specifically decreased heart rate (but not blood pressure) and the risk of cardiovascular events in patients with heart failure or coronary artery disease, decreased left ventricular function and resting heart rate of ≥ 70 beats/minute. Selective heart rate reduction is a potential treatment option to decrease cardiovascular risk.