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Ivabradine - not only Pure Heart Rate Reduction?

Lucia Jedlickova, Lucia Merkovská, Lucia Jackova, Jan Fedacko and Daniel Pella

According to data of the World Health Organization, cardiovascular diseases belong to the leading causes of death worldwide. In addition, the ischemic heart disease is the number one cause of death. Chronic stable angina pectoris is the most frequent symptom or form of the ischemic heart disease. High heart rate appears to play an important role in its patophysiology, since it takes part in the development of the endothelial dysfunction at the atherosclerosis’ onset. Current pharmacotherapy of the stable angina pectoris is limited. The development of ivabradine, which is a selective and specific inhibitor of the If current in the sinus node, enabled new possibilities in its management. Ivabradine’s antianginal properties were tested in many randomised, placebo controlled clinical studies. Nowadays, it is indicated as a second-line therapy for patients, who cannot be treated with betablockers because it would be unsuitable or insufficient with respect to reaching adequate heart rate. The aim of this review is to provide information about the development and mechanism of action of ivabradine, discuss about its possible pleiotropic effects, provide an information about clinical trials with ivabradine, and describe current status of ivabradine in clinical practice. Supported by grant VEGA number 1/0858/11.