Antianginal Efficacy of Ivabradine/Metoprolol Combination in Patients With Stable Angina

• Published in: Clinical cardiology (Mahwah, N.J.) N.J.), 2016-12, Vol.39 (12), p.697-702
• Main Authors: Zarifis, John, Kallistratos, Manolis, Katsivas, Apostolos
• Format: Article
• Language: English
• Subjects: Adrenergic beta-1 Receptor Antagonists - administration & dosage; Aged; Angina, Stable - drug therapy; Angina, Stable - physiopathology; Benzazepines - administration & dosage; Cardiovascular Agents - administration & dosage; Clinical Trial Updates; Cyclic Nucleotide-Gated Cation Channels; Dose-Response Relationship, Drug; Drug Therapy, Combination; Electrocardiography; Female; Follow-Up Studies; Humans; Ivabradine; Male; metoprolol; Metoprolol - administration & dosage; nitroglycerin consumption; Prospective Studies; Quality of Life; Stable angina; Surveys and Questionnaires; Treatment Outcome
• ISSN: 0160-9289; 1932-8737
• DOI: 10.1002/clc.22585

Medical treatment is the main clinical strategy for controlling patients with chronic stable angina and improving their quality of life (QoL). Ivabradine treatment on top of metoprolol decreases angina symptoms and improves QoL in patients with stable angina and coronary artery disease (CAD). This is a post hoc analysis (636 CAD patients given ivabradine/metoprolol free combination) of a prospective, noninterventional study that included 2403 patients with CAD and stable angina. Data were recorded at baseline at 1 and 4 months after inclusion. Patient QoL was assessed using the EQ‐5D questionnaire. From baseline to study completion; ivabradine administration on top of metoprolol decreased heart rate (HR) from 80.8 ± 9.6 to 64.2 ± 6.2 bpm (P < 0.001). Mean number of angina attacks decreased from 2.0 ± 2.0/wk to 0.2 ± 0.6/wk (P < 0.001), whereas nitroglycerin consumption decreased from 1.4 ± 1.9 times/wk to 0.1 ± 0.4 times/wk (P < 0.001). The percentage of patients in Canadian Cardiovascular Society angina class III to IV decreased from 15.4% to 1.9% (P < 0.001). The improvement of symptoms and angina class led to a significant 14.7‐point increase in EQ‐5D questionnaire score (P < 0.001). Patients with increased HR showed greater improvement (P = 0.001). Adherence to treatment during the entire trial was high (98%). Ivabradine combined with metoprolol significantly decreased angina symptoms and use of nitroglycerin in patients with stable angina and CAD, leading to improved QoL. The benefits observed with this combination explain the high rate of adherence to treatment.