Pharmacologic management of stable angina: role of ivabradine

The current management of patients with stable angina involves control of symptoms, prevention of major cardiovascular events, and treatment of risk factors. Usually, this requires the prescription of multiple pharmacological agents. Recent registries have shown that, despite the use of polypharmacy, many patients have poor symptom control, poor compliance with therapy, suboptimal dosages of drugs, or side effects from medications. In addition, the choice of anti-anginals is often limited in patients with comorbidities, such as heart failure or asthma. Overall, persistent symptoms and/or side effects from treatments affect the quality of life of angina patients. Ivabradine is a specific inhibitor of the If current that lowers heart rate without impacting contractility, conduction, or repolarization. It is safe and its most frequent side effects are mild, dose-related, transient, and reversible visual symptoms. Its clinical efficacy has been established by a series of randomized trials, which have, in particular, outlined that ivabradine is non-inferior to atenolol or amlodipine, has prolonged efficacy over 1 year and is well tolerated. This promising agent has a role in the management of patients with stable angina, particularly when beta-blockers are contraindicated or poorly tolerated, and in addition to other anti-anginals when control of symptoms is insufficient.