title: The Role of Ivabradine in the Management of Angina Pectoris.
abstract: Stable angina pectoris affects 2-4 % of the population in Western countries and entails an annual risk of death and nonfatal myocardial infarction of 1-2 % and 3 %, respectively. Heart rate (HR) is linearly related to myocardial oxygen consumption and coronary blood flow, both at rest and during stress. HR reduction is a key target for the prevention of ischemia/angina and is an important mechanism of action of drugs which are recommended as first line therapy for the treatment of angina in clinical guidelines. 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. However, recent clinical trials of ivabradine have failed to show prognostic benefit and have raised potential concerns about safety. This article will review the available evidence base for the current role of ivabradine in the management of patients with symptomatic angina pectoris in the context of stable coronary artery disease.
authors.affiliation: NIHR Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Giavarini
authors.affiliation: NIHR Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK. r.desilva@imperial.ac.uk.|ICMS, Royal Brompton and Harefield NHS Foundation Trust, London, UK. r.desilva@imperial.ac.uk.|National Heart and Lung Institute (Brompton Campus), Imperial College London, Level 2 Chelsea Wing, London, SW3 6NP, UK. r.desilva@imperial.ac.uk.
authors.forename: Ranil
authors.initials: R
authors.lastname: de Silva
mesh_terms: D000787:Angina Pectoris / Q000188:drug therapy* / Q000503:physiopathology; D001552:Benzazepines / Q000009:adverse effects / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use*; D002317:Cardiovascular Agents / Q000009:adverse effects / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use*; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D000077550:Ivabradine
chemical_list: D001552:Benzazepines; D002317:Cardiovascular Agents; D000077550:Ivabradine
keywords: Angina pectoris; If current inhibitor; Ivabradine; Stable coronary artery disease