New results with ivabradine

Angina pectoris is a common manifestation of coronary artery disease (CAD) and there is a need to improve quality of life, by reducing associated symptoms, and prognosis, by preventing acute coronary events. Ivabradine is a new medication which lowers heart rate (HR) by selectively inhibiting the If current without other direct cardiovascular effects. The antianginal and anti-ischaemic properties of ivabradine in patients with stable angina have been well demonstrated by placebo-controlled trials. This review analyses the results of two recently reported trials. The ASSOCIATE study showed that ivabradine, at the commonly used dose of 7.5 mg bid in patients with stable angina pectoris, on top of atenolol 50 mg daily was associated with a significant increase in exercise test parameters. In the BEAUTIfUL trial in patients with stable CAD and left ventricular dysfunction, ivabradine significantly reduced the risk of coronary events, in patients with HR ≥70 b.p.m. Furthermore, a subgroup analysis of the placebo arm showed prospectively that patients with HR ≥70 b.p.m. are at higher risk of coronary events. Both trials showed that ivabradine was well tolerated and could be safely combined with other currently used cardiovascular agents.