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Ivabradine – the beauty of a slow heart rate

Over the last few years, there has been increasing interest in heart rate as a risk factor for cardiovascular disease. An elevated resting heart rate has been shown to be an independent predictor of cardiovascular morbidity and mortality (1-4) and is associated with a greater incidence of sudden cardiac death (5,6). It has been postulated that heart rate may be a marker of sympathetic nervous system activation (7), which may lead to insulin resistant states if over-stimulated in the long-term, thereby increasing the metabolic risk factors for cardiovascular disease (8). Within coronary artery disease, raised heart rates are associated with greater atherosclerosis (9) and plaque disruption, probably because of increased wall stress (10).