Ivabradine: I(f) inhibition in the management of stable angina pectoris and other cardiovascular diseases.

Elevated heart rate plays a major role in coronary artery disease, not only as a trigger of most ischemic episodes but also as a significant predictor of cardiovascular morbidity and mortality. Heart rate is an important target in the management of stable angina pectoris. Against this background, a new class of antianginal drugs has recently become available: the selective and specific I(f) inhibitors. The mode of action of this novel class involves selective and specific inhibition of the major pacemaker current in the sinoatrial node, the mixed sodium/potassium current (I(f)), which results in pure heart rate reduction. The first member of this class available for clinical use is ivabradine (available under the brandnames of Procoralan, Coralan, Corlentor, Coraxan, Servier, France). Building on solid preclinical studies, ivabradine was shown to have anti-ischemic and antianginal efficacy in patients with stable angina pectoris in clinical trials versus placebo, beta-blockers and calcium channel blockers. Ongoing studies will determine the potential of pure heart rate reduction with ivabradine to improve morbidity and mortality.