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BEAUTIFUL: Ivabradine did as well as placebo
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MUNICH — The much-awaited results of the BEAUTIFUL trial showed that when compared with placebo, the drug did not have an effect on cardiovascular death or admission to the hospital for MI or heart failure.
However, results presenter Kim Fox, MD, president of the European Society of Cardiology, said that ivabradine (Procoralan, Servier) reduced the risk of fatal and nonfatal MI by 36% and coronary revascularization by 30% among patients with CAD and left ventricular dysfunction, even when those patients were already receiving optimal medical therapy. The study also demonstrated that patients with a heart rate >70 bpm are more likely to die or suffer from another CV event; the increase in risk is 34% for CV death, 46% for MI, 56% for HF and 38% for coronary revascularization.
“The conclusions that we draw regarding the reduction in fatal and nonfatal MI are to a great extent, hypothesis-generated,” Fox said during a press conference prior to his presentation. “What's less hypothesis-generating is that these patients were on treatment with beta-blockade, and that in terms of the primary indication for the drug that is antianginal, the drug can certainly be safely used in conjunction with beta blockade...The fatal and nonfatal MI [results] are reassuring but they are not definitive.”
I see no reason to change our current guideline-recommended therapy for patients with left ventricular dysfunction but I'd like to think that a prospective study is needed to evaluate the potential benefits of ivabradine on CAD and the outcomes among patients with heart rates greater than 70 bpm.
Sidney C. Smith, MD
Director of the Center for CV Science and Medicine, University of North Carolina
For more information:
- Fox K. Hotline I.