Ivabradine: advantages throughout the cardiovascular continuum

Abstract

The evidence-based concept of the cardiovascular disease (CVD) continuum is based on the hypothesis that CVD is the result of a chain of events initiated by risk factors leading to the end-stage of the disease, and that any interruption along this chain of events may interrupt the pathological process. Epidemiological studies, experimental data, and clinical observations show that heart rate plays a key role at different points in the CVD continuum. Heart rate has been shown in recent years to be an independent risk factor of mortality and morbidity in various populations, including patients with CVDs. Therefore, heart rate reduction by the heart rate-lowering agent ivabradine should lead to prevention of cardiovascular events. Ivabradine is the first If current inhibitor licensed for clinical use. Its anti-ischaemic properties and usefulness in the relief of ischaemia and angina have been proved by randomized controlled trials in patients with stable angina. Ivabradine has been shown to be an effective antianginal agent alone or in combination with beta-blocker. Furthermore, the BEAUTIFUL study showed that in patients with stable coronary artery disease and left ventricular systolic dysfunction and a heart rate ≤70 b.p.m., ivabradine was also associated with a 36% reduction in hospitalization for fatal and non-fatal myocardial infarction, despite the fact that patients received excellent treatments known to improve prognosis. Besides its benefits in stable angina, ivabradine potentially also has beneficial effects in systolic and diastolic heart failure. The ongoing SHIFT trial will assess whether ivabradine can reduce cardiovascular outcomes in patients with chronic heart failure and left ventricular systolic dysfunction. The SIGNIFY study will assess the effect of ivabradine in patients with stable coronary artery without clinical symptoms of heart failure.