Ivabradine efficacy and safety in treatment of chronic stable angina

An elevated heart rate is an established marker of cardiovascular risk. Previous analyses have suggested that ivabradine, a heart-rate–reducing agent, may improve outcomes in patients with stable coronary artery disease, left ventricular dysfunction, and a heart rate of 70 beats per minute or more. Ivabradine is known to improve outcomes in patients with systolic heart failure. A trial of ivabradine involving patients with coronary artery disease and left ventricular systolic dysfunction did not show clinical benefit,1 but post hoc analyses suggested that ivabradine improved outcomes in patients who had a heart rate of 70 beats per minute or more, particularly in those with angina. However, many patients are often unable to tolerate the doses of beta blocker or non-dihydropyridine calcium antagonists required to achieve the desired symptom control. The selective pacemaker current inhibitor ivabradine was developed as a drug for the management of patients with angina pectoris, through its ability to reduce HR specifically. The available data suggest that ivabradine is a well-tolerated and effective anti-anginal agent and it is recommended as a second-line agent for relief of angina in guidelines. This review article aims to evaluate the antianginal and anti-ischaemic efficacy of the selective If current inhibitor ivabradine in patients with chronic stable angina pectoris receiving beta-blocker therapy.