Slowing down heart rate cuts MI risk

Taking the heart rate inhibitor ivabradine can reduce the risk of heart attacks by 36 per cent in patients with stable coronary artery disease (CAD), UK re-search suggests.

It is the first time a study has shown that using a drug to lower heart rate can lead to a reduction in coronary events in patients already receiving optimal therapy.

The findings mean heart rate should be added to the quality framework immediately, said Berkshire GP Dr George Kas-sianos, a member of the British Cardiology Society.

Findings from the BEAUTIFUL trial, presented to cardiologists in Munich this week, involved 10,917 patients with a resting heart rate of over 60 beats per minute (bpm), with stable CAD and left ventricular systolic dysfunction. The patients were randomly assigned either 5mg of ivabradine daily or placebo. Some 87 per cent of the patients were already receiving treatment with beta-blockers.

After the 19-month follow-up period, the researchers found that in patients with a heart rate over 70bpm, ivabradine cut the risk of hospitalisation for fatal and non-fatal MI by 36 per cent compared with placebo. The risk of coronary revascularisation was cut by 30 per cent for these patients and angina risk by 22 per cent.

Lead researcher Professor Kim Fox, consultant cardiologist at the Royal Brompton Hospital in London, said: 'Ivabradine can be used with beta-blockers to prevent MI and angina.

'It will reduce heart rate in everybody, it is very effective.'

He said lowering heart rate was safe as ivabradine would not cause hearts to stop. 'Ivabradine works on the sinus node. You could completely block it and the heart would still not stop.'

Dr Kassianos said: 'GPs should prescribe beta-blockers as per protocol and maximise the dose. If this does not reduce heart rate in CAD patients to below 70bpm, they should be put on ivabradine as well.'

Lancet Online 2008

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