Ivabradine for the Management of Chronic Stable Angina: Should it beconsidered?

Angina, or chest pain, often occurs when oxygen demand of the heart exceeds oxygen supply. The imbalance between oxygen supply and demand may be due to blockage in the coronary arteries, arterial vasospasm, or myocardial dysfunction [1]. Chronic stable angina (CSA) is described as having chest pain due to exertion (such as exercise or stress), or chest pain that is relieved by rest or administration of nitroglycerin [2]. Conventional therapies for CSA includes negative inotropes, such as beta blockers (BB) and calcium channel blockers (CCB), or vasodilators, such as nitroglycerin (NTG). Unfortunately, BBs and CCBs have been associated with adverse effects such as fatigue and severe bradycardia, while use of NTG may lead to severe hypotension and headache [1]. Ivabradine is a new class of medication, and works by blocking the If current in the sinoatrial node to slow down heart rate. By lowering the heart rate, it decreases workload and oxygen demand for the heart [3]. In the European Union, ivabradine was approved for the management of symptoms on CSA in patients with history of coronary artery disease (CAD), or for the management of heart failure (HF). Prior to initiating ivabradine for the management of CSA, patients must have heart rates of at least 70 beats per minute, and either cannot tolerate beta blocker therapy, or whose symptoms are not adequately controlled by beta blocker therapy alone [4]. In the United States, ivabradine is only approved for the management of HF, but not for CSA [3].