Statistics from Altmetric.com
BEAUTIFUL: no go for go slow with ivabradine?
Ivabradine is a pure heart-rate-lowering agent that is a specific inhibitor of the If current in the sinoatrial node; currently it is licensed for the treatment of angina. The BEAUTIFUL (morBidity–mortality EvAlUaTion of the If inhibitor ivabradine in patients with coronary disease and left-ventricULar dysfunction) trial aimed to determine if heart rate lowering with ivabradine could reduce cardiovascular death and mortality in patients with stable coronary artery disease and impaired systolic function (<40%), as several studies have demonstrated that a high heart rate is an independent predictor of both cardiovascular and all-cause mortality.
A total of 10 917 eligible patients were enrolled in a randomised, double-blind, placebo-controlled, parallel-group manner. Of these, 5479 patients received 5 mg ivabradine, with the intention of increasing to the target dose of 7.5 mg twice a day, and 5438 received matched placebo in addition to their other cardiac drugs. The primary end point was a composite of cardiovascular death, and admission to hospital for new-onset or worsening heart failure.
Mean (SD) heart rate at baseline was 71.6 (9.9) bpm; over a median follow-up of 19 months ivabradine reduced heart rate by 6 bpm (SE 0.2) at 12 months, corrected for placebo. Of note, 87% patients were concomitantly taking β blockers, but no safety concerns were noted. Ivabradine did not affect the primary composite end point (hazard ratio (HR) = 1.00, p = 0.94), and 1233 patients (22.5%) in the treatment group had serious events, compared with 1239 (22.8%) in the control group (p = 0.17). Treatment did reduce the secondary end points of non-fatal myocardial infarction (HR = 0.64, p = 0.001) and coronary revascularisation (HR = 0.70, p = 0.016).
Thus although the study failed to reach its primary outcome, the data acquired seem to demonstrate the safety of giving ivabradine, even in combination with a β blocker. Although a direct comparison between these two drugs would …
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.