伊伐布雷定治疗稳定性心绞痛的安全性和有效性

J. Tardif
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引用次数: 0

摘要

第一种选择性If抑制剂,伊伐布雷定,在休息和运动时降低心率(HR),无血管舒缩、负性肌力或负性肌力效应。静息心率升高是心肌缺血发生的关键因素,也是心血管预后的一个强有力的独立预测因素,因此伊伐布雷定为冠状动脉疾病(CAD)的治疗提供了新的前景。其选择性降hr作用已被证实具有抗缺血和抗心绞痛的功效,目前伊伐布雷定用于稳定型心绞痛的对症治疗。伊伐布雷定也可与其他抗心绞痛药物安全联用,在β受体阻滞剂治疗的基础上加用伊伐布雷定可进一步提高稳定型心绞痛患者的抗缺血疗效和运动能力。最近的BEAUTIFUL试验表明,尽管在总体人群中没有达到主要终点,但在标准预防性治疗的基础上,在静息心率≥70 bpm的患者亚组中,伊伐布雷定显著降低了伴有左室收缩功能障碍的稳定型CAD患者冠状动脉事件的风险。这与临床前数据一致,表明长期HR降低可改善内皮功能并减缓动脉粥样硬化的进展。相当比例的稳定型心绞痛患者静息心率升高,因此应将伊伐布雷定视为这些病例的重要治疗方法。与其他标准治疗相结合,伊伐布雷定可以改善心绞痛,并可能改善冠状动脉的预后。正在进行的和未来的临床研究将评估伊伐布雷定在心血管疾病患者中降低HR的存在和程度。
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Safety and Efficacy of Ivabradine in the Management of Stable Angina Pectoris
The first selective If current inhibitor, ivabradine, lowers heart rate (HR) at rest and during exercise with no vasomotor, negative inotropic, or negative lusitropic effects. Given that elevated resting HR is a key factor in the onset of myocardial ischemia and a strong independent predictor of cardiovascular outcomes, ivabradine provides new therapeutic prospects in coronary artery disease (CAD). Its selective HR-lowering action has proven anti-ischemic and anti-anginal efficacy, and ivabradine is currently indicated for the symptomatic treatment of stable angina pectoris. Ivabradine can also be safely combined with other anti-anginal agents, and addition of ivabradine to beta-blocker therapy further improves anti-ischemic efficacy and exercise capacity of patients with stable angina. The recent BEAUTIFUL trial demonstrated that although the primary endpoint was not met in the overall population, addition of ivabradine on top of standard preventive treatments significantly reduced the risk of coronary events in stable CAD patients with left ventricular systolic dysfunction among the subgroup of patients with a resting HR ≥ 70 bpm. This is in accordance with pre-clinical data showing that long-term HR reduction improves endothelial function and reduces the progression of atherosclerosis. A significant proportion of patients with stable angina have elevated resting HR and ivabradine should therefore be considered as an important therapy in these cases. In combination with other standard treatments, ivabradine can improve angina and could potentially improve coronary outcomes. Ongoing and future clinical studies will evaluate the presence and magnitude of the cardio-protective benefits of HR lowering with ivabradine in patients with cardiovascular diseases.
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