Ivabradine - A novel treatment for chronic stable angina

Abstract

Heart rate is an important determinant of myocardial oxygen consumption and elevated heart rate is a known risk factor in coronary artery disease. Heart rate reduction has been the cornerstone of antianginal and antiischemic therapy for many years and is most often achieved by β-blockers. The discovery of the f-channel and its role in regulating pacemaker activity in the sinoatrial node led to the development of new pharmacological agents such as ivabradine, which target these f-channels causing a reduction in heart rate by inhibiting the If current. Due to its specific and selective action, ivabradine does not display any of the negative inotropic peripheral vascular or central nervous system side-effects that have limited the use of β-blockers in some patients. Ivabradine efficacy has been investigated in a large clinical development programme involving 5000 participants including over 3500 patients with chronic stable angina, and was shown to reduce resting and exercise induced heart rate without modifying any electrophysiological parameters. It has been shown to reduce heart rate at rest and during exercise and improve measurable parameters of angina in a dose-dependent manner. Its antiianginal and antiischemic effects have also has been shown to be non-inferior to commonly use doses of atenolol and amlodipine. Ivabradine is currently licensed for oral use at 5 and 7.5mg twice daily for symptomatic treatment of chronic stable angina in patients with normal sinus rhythm who are either intolerant of β-blockers or for whom they are contraindicated. © 2008 CSF Medical Communications Ltd.