[Heart rate as a cardiovascular risk factor: potential clinical benefit with ivabradine].

Elevated resting heart rate is an independent cardiovascular risk factor and rate reduction is beneficial. It is not known whether reduction of heart rate per se can improve outcome. Studies of beta-blockers in post-myocardial infarction patients suggest that this may be the case, but beta-blockers, may be poorly tolerated or contraindicated. Similarly, heart rate lowering calcium antagonists are associated with modest event-rate reduction only in selected patients. The new selective inhibitor of the sinus node If current, ivabradine, looks promising in terms of reducing myocardial ischaemia. Its mode of action, the exclusive reduction of heart rate through selective inhibition of the sinus node If current, provides comparable efficacy to existing treatments. Ivabradine is licensed in Europe for use in stable angina.