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Published on: December 28, 2012

Heart rate in coronary artery disease: should we lower it?

Kelly Axsom1, Sripal Bangalore

  • 1The Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, NY, 10016, USA.

Current Treatment Options in Cardiovascular Medicine
|October 30, 2012
PubMed

Insights

Elevated resting heart rate is a risk factor for cardiovascular events. This study explores if selectively lowering heart rate with ivabradine benefits patients with stable coronary artery disease, without heart failure.

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Elevated resting heart rate (RHR) is an independent risk factor for cardiovascular morbidity and mortality.
  • In coronary artery disease (CAD), high RHR exacerbates myocardial ischemia by reducing diastolic filling time and increasing cardiac workload.
  • The prognostic significance of RHR and the efficacy of pharmacological heart rate reduction remain unclear.

Purpose of the Study:

  • To investigate the potential benefits of selectively lowering heart rate with ivabradine in patients with stable coronary artery disease without heart failure.
  • To differentiate the effects of heart rate reduction from other cardiovascular actions of medications like beta-blockers.

Main Methods:

  • Review of existing literature on heart rate, cardiovascular outcomes, and pharmacological interventions.
  • Analysis of the mechanism of action of ivabradine, focusing on selective I(f) current inhibition.
  • Comparison of ivabradine's effects with those of beta-blockers in cardiovascular patients.

Main Results:

  • Ivabradine selectively lowers heart rate by inhibiting the I(f) current, without other significant cardiovascular effects.
  • Beta-blockers, while lowering heart rate, also possess other cardiovascular effects, complicating the interpretation of their benefits.
  • Early trials suggest promise for ivabradine in heart failure patients.

Conclusions:

  • Ivabradine represents a novel therapeutic approach targeting heart rate reduction selectively.
  • Further research is needed to establish the efficacy and safety of ivabradine in patients with stable coronary artery disease without heart failure.
  • Distinguishing the direct effects of heart rate reduction from other drug-induced effects is crucial for optimizing cardiovascular treatment.
Abstract

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