Preface
Since the classic description of angina by Heberden, the relief of myocardial ischaemia and its clinical manifestations have played a central role in cardiology. Nowadays, surgical and interventional treatments on atherosclerotic coronary arteries have improved the scene since the times of Heberden. However, the number of patients in whom angina or silent myocardial ischaemia still persists is large. These patients need medical treatment not only to prevent thrombosis or the progression of atherosclerosis but also to protect them from myocardial ischaemia and angina. Heart rate is an obvious factor in energy consumption by the heart and, therefore, heart rate control is a must in the control of ischaemia. The If ionic current is now considered as the main component of the ‘physiological pacemaker’. The pharmacological control of If is thus a powerful tool to reduce heart rate and, in turn, to keep angina and ischaemia under control when this is appropriate.
The present issue of the European Heart Journal Supplements is authored by a panel of experts who review the current status of angina control, including pharmacological, interventional, and lifestyle actions. Their rationale for heart rate control is illustrated and so is the role of If current inhibition in this control. Ivabradine is a new drug which selectively inhibits If and so it effectively reduces heart rate. Pharmacological evidence of ivabradine is sound and makes this drug some kind of ‘ideal’ heart rate speed control, without untoward side effects on atrioventricular conduction, repolarization, inotropism, or lusotropism. In contrast, clinical evidence is still scarce, but available information shows that ivabradine is a useful, well-tolerated, anti-anginal drug. Ivabradine may be a good alternative to, or combination with, existing anti-anginal drugs.
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