Ivabradine has a neutral effect on mortality in randomized controlled trials. Issue 40 (October 2017)

• Record Type: Journal Article
• Authors: Kang, Sheng; Li, Chong-Jian; Zhang, Xu-Min
• Other Names: Schaller. Bernhard section editor.
• Is Part Of: Medicine. Volume 96:Issue 40(2017)
• Publication Date: 2017-10
• Subjects: all-cause death -- cardiovascular disease death -- ivabradine -- randomized controlled trials; Medicine -- Periodicals; Medicine -- Periodicals; Médecine -- Périodiques; Geneeskunde; Medicine; Periodicals; Periodicals; 610.5
• DOI: 10.1097/MD.0000000000008067
• Languages: English
• ISSNs: 0025-7974

Abstract

Abstract: Background: It has long been a controversial hotspot whether resting heart rate (RHR) is a risk factor or a marker for death. Ivabradine, a specific inhibitor of the If current in the sinoatrial node, is a pure RHR lowering agent. The study was aimed to investigate whether ivabradine would reduce more RHR, cardiovascular disease (CVD) mortality, and all-cause mortality than those placebo or beta-blockers. Methods: The authors performed a meta-analysis of 8 randomized controlled clinical studies (with 40, 357 participants), and 3 studies of those which were ivabradine versus placebo (36, 069 participants) and other 5 studies ivabradine versus beta-blockers (4288 participants) were available. The authors compared the association of the RHR reduction with death from CVD causes (2674 in 40, 285 participants) and the rate of all-cause death (3143 deaths in 38, 037 participants), and assessed improvement in death rates with the use of ivabradine. Results: The change of RHR from baseline to endpoint was 8 to 16 beats/min (bpm) in ivabradine group, 1 to 8 bpm in placebo group, and 4 to 24 bpm in beta-blockers group. In ivabradine versus placebo, the reduced risks of CVD mortality and all-cause morbidity were not significantly (risk ratio [RR] 1.02; 95% confidence interval [CI] 0.91–1.14, P = .737; RR: 1.00, 95% CI: 0.92–1.09, P = .992, respectively). CVD and all-cause morbidity were similar for ivabradine versus beta-blockers (RR: 1.04; 95% CI: 0.80–1.37, P = .752; RR: 1.17, 95% CI: 0.53–2.60, P = .697, respectively). Conclusions: Ivabradine had a neutral effect on mortality, suggesting that a pure RHR lowering agent did not reduce CVD mortality, all-cause mortality and improve the lifespan.