Evaluating the effectiveness and safety of ivabradine in combination with beta-blockers in patients with stable angina.

This study evaluated the effectiveness and safety of ivabradine (Procoralan) in combination with beta-blockers in patients with stable angina. The data showed that the combination of ivabradine plus beta-blocker therapy effectively reduced heart rate, angina symptoms, and the use of short-acting nitrates from the first month of treatment and was safe with manageable side effects in these patients.

Coronary artery disease (CAD) is a condition in which the blood vessels in the heart become blocked. This reduces the blood flow to the heart. Angina is chest pain caused by the reduced flow of blood to the heart. Stable angina is the most common type and has a regular pattern. It can be predicted when the pain will occur. Atherosclerosis (build-up of substances in the blood vessels) can cause stable angina.

The first-line therapy recommended for patients with angina is beta-blockers such as metoprolol (Lopressor). This type of treatment reduces heart rate which reduces in turn the oxygen consumption of heart cells. This reduces overall angina symptoms. Ivabradine is a drug used to treat stable angina in patients who cannot receive beta-blockers. Some patients also use another type of medication, called nitrates such as nitroglycerine (Nitrostat). These are put under the tongue, to reduce angina symptoms during angina episodes. 

It is important to reduce angina symptoms in patients with stable angina. Whether ivabradine in combination with beta-blockers improves symptoms of angina in patients who still have symptoms with beta-blocker treatment is still unknown.

This study analyzed 7 other studies and involved 6821 patients with stable angina. Patients received ivabradine plus beta-blocker combination therapy compared to placebo or other second-line angina treatments.

Ivabradine plus a beta-blocker consistently reduced heart rate, anginal symptoms, and the need for short-acting nitrates within 1 month of initiating therapy. These reductions were maintained for up to 4 months.

0.1% of the patients experienced a low heart rate (bradycardia). 

This study concluded that the combination of ivabradine plus beta-blocker therapy effectively reduced heart rate, angina symptoms, and the use of short-acting nitrates in patients with stable angina. The authors suggested that ivabradine plus beta-blockers might be a useful antianginal treatment option in these patients.

The sample sizes were very small. Most studies were observational, from real-life medical practice. Further randomized clinical trials are needed to validate these results.