Cor Vasa 2009, 51(3):220-223

Ivabradine, heart rate and cardiovascular risk. A commentary on the BEAUTIFUL trial

Tomáš Štulc

3. interní klinika, Centrum preventivní kardiologie, Všeobecná fakultní nemocnice a 1. lékařská fakulta Univerzity Karlovy, Praha, Česká republika

The BEAUTIFUL trial investigated the effect on cardiovascular outcomes of the If inhibitor ivabradine in nearly 11,000 patients with coronary artery disease and left ventricular dysfunction. The only pharmacological effect of ivabradine is heart rate reduction, and BEAUTIFUL was thus the first study to directly evaluate the effect of slowing heart rate on cardiovascular risk. Results of the study are negative: ivabradine failed to demonstrate a reduction of the primary composite endpoint or any of its components, and there was not even a trend towards improvement to suggest any beneficial effect of the treatment. Based on these results, mere heart rate reduction appears unlikely to be beneficial in the majority of patients with cardiovascular disease. However, BEAUTIFUL indicated a substantial heterogeneity in the clinical effects of ivabradine: in patients with higher baseline heart rates, ivabradine might decrease the risk of coronary events while an effect on heart failure is unlikely; in patients with lower baseline heart rates, ivabradine may even increase cardiovascular risk. More data from further trials are therefore needed to evaluate the efficacy and safety of ivabradine to establish its potential role in the treatment of cardiovascular disease.

Keywords: BEAUTIFUL trial; Ivabradine; Heart rate reduction; Cardiovascular risk

Published: March 1, 2009  Show citation