Article Text
Abstract
In chronic stable angina, elevated heart rate contributes to the development of symptoms and signs of myocardial ischaemia by increasing myocardial oxygen demand and reducing diastolic perfusion time. Accordingly, heart rate reduction is a well-known strategy for improving both symptoms of myocardial ischaemia and quality of life (QOL). The heart rate-reducing agent ivabradine, a direct and selective inhibitor of the I f current, decreases myocardial oxygen consumption while increasing diastolic time, without affecting myocardial contractility or coronary vasomotor tone. Ivabradine is indicated for treatment of stable angina and chronic heart failure (HF). This review examines available evidence regarding the efficacy and safety of ivabradine in stable angina, when used as monotherapy or in combination with beta-blockers, in particular angina subgroups and in patients with stable angina with left ventricular systolic dysfunction (LVSD) or HF. Trials involving more than 45 000 patients receiving treatment with ivabradine have shown that this agent has antianginal and anti-ischaemic effects, regardless of age, sex, severity of angina, revascularisation status or comorbidities. This heart rate-lowering agent might also improve prognosis, reduce hospitalisation rates and improve QOL in angina patients with chronic HF and LVSD.
- ivabradine
- angina
- antianginal drug
- comorbidities
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Footnotes
Contributors The initial drafting and subsequent writing of the manuscript was carried out by JCK. All authors contributed substantially to the manuscript, revised the final draft critically and gave final approval for submission for publication.
Funding The manuscript was produced following a scientific meeting funded by an unrestricted educational grant from Servier.
Competing interests JCK has received speaker honoraria from Menarini, Servier and Teva Pharma, and honoraria from Bayer, Sanofi and Menarini, for advisory committee membership. BIL is a consultant for Servier and has received speaking fees from Roche and Bayer. MK has received honoraria for consulting activities/lectures from Servier, Novartis, Sanofi, MSD, Novo Nordisk and BMS. PGC is a consultant for Servier and has received speaker fees from Menarini. RF has received honoraria from Servier and Novartis for steering committee membership, consulting and speaking. RF has received support for travel to study meetings from Amgen, Boehringer Ingelheim, Bayer, Merck Serono and Servier. KF reports personal fees from Servier, AstraZeneca, TaurX, Broadview Ventures and CellAegis, and non-financial support from Servier, Armgo and Broadview Ventures; he is the director of Heart Research Ltd and Vesalius Trials Ltd and minimal stockholder of Armgo and CellAegis.
Patient consent Not required.
Provenance and peer review Not commissioned; externally peer reviewed.