Borer Jeffrey S
Division of Cardiovascular Pathophysiology and The Howard Gilman Institute for Valvular Heart Diseases, Weill Medical College of Cornell University, The New York-Presbyterian Hospital Weill Cornell Medical Center, New York, N.Y., USA.
Adv Cardiol. 2006;43:54-64. doi: 10.1159/000095428.
Heart rate slowing is generally accepted as effective for angina prevention but this approach has not been rigorously evaluated as no pure heart rate slowing treatment has been available. With the identification of the I(f) current, the primary modulator of heart rate, and use of this as a target for drug development, the role of isolated heart rate slowing can be elucidated. More than 4,000 patients now have been studied in angina prevention trials with ivabradine, a prototype I(f) current inhibitor devoid of other cardiovascular effects. These studies demonstrate the efficacy of isolated heart rate slowing for angina prevention. Indeed, in one direct comparison with atenolol involving 939 patients, ivabradine not only was non inferior to the Beta-blocker but nominally appeared to be more efficient in angina prevention. Moreover, since ivabradine is devoid of most of the adverse effects of beta-blockers (and of calcium channel blockers), it is a suitable alternative when these established drugs are not adequately tolerated. Additional studies now must assess other potential actions in patients with coronary disease.
心率减慢通常被认为对预防心绞痛有效，但由于一直没有单纯的心率减慢治疗方法，这种方法尚未得到严格评估。随着心率主要调节因子I(f)电流的发现，并将其作为药物研发的靶点，单纯心率减慢的作用得以阐明。目前已有4000多名患者参与了使用伊伐布雷定（一种无其他心血管效应的I(f)电流原型抑制剂）预防心绞痛的试验。这些研究证明了单纯心率减慢对预防心绞痛的有效性。事实上，在一项涉及939名患者的与阿替洛尔的直接对比研究中，伊伐布雷定不仅不劣于β受体阻滞剂，而且在预防心绞痛方面名义上似乎更有效。此外，由于伊伐布雷定没有β受体阻滞剂（和钙通道阻滞剂）的大多数不良反应，当这些成熟药物耐受性不佳时，它是一个合适的替代选择。现在必须开展更多研究来评估其在冠心病患者中的其他潜在作用。
