Efficacy of Ivabradine, a Selective If Inhibitor, in Patients With Chronic Stable Angina Pectoris and Diabetes Mellitus
Efficacy of Ivabradine, a Selective If Inhibitor, in Patients With Chronic Stable Angina Pectoris and Diabetes Mellitus
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DOI：
10.1016/j.amjcard.2009.08.642
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发表时间：
2010-01-01
影响因子：
2.8
通讯作者：
Tardif, Jean-Claude
中科院分区：
文献类型：
--
作者：
Borer, Jeffrey S.;Tardif, Jean-Claude
伊夫拉定是一种特殊的降低心率的抗心绞痛药物，在一项涉及大约3000名稳定性冠状动脉疾病患者的临床开发计划中进行了评估，其中大多数患者患有心绞痛。在这个项目中，我们分析了伊夫拉定在糖尿病(DM)患者中的药代动力学、有效性(通过运动耐量试验进行评估)、安全性以及对糖代谢的影响。大多数分析包括糖尿病患者的数据，约占患者总样本的18%。与非糖尿病患者相比，糖尿病患者年龄更大，更有可能是女性，并且更有可能患有更严重的心绞痛。糖尿病患者和非糖尿病患者伊夫拉定的药代动力学无差异。服用伊夫拉定后，糖尿病患者的静息心率减慢幅度与非糖尿病患者相似(15.2%和15.7%)。在基线时，糖尿病患者的运动能力倾向于较低，但在糖尿病患者和非糖尿病患者中，使用伊夫拉定治疗的大多数运动耐量指标的改善情况相似。在糖尿病患者中，伊夫拉定没有特别的安全性问题。在糖尿病患者中，窦性心动过缓和视力障碍的发生率没有相对增加，这些已知与伊夫拉定的作用有关。伊夫拉定治疗与糖代谢的不良反应无关。总之，伊夫拉定在预防糖尿病患者心绞痛方面是有效的，与特定的安全问题或对糖代谢的不良影响无关。在稳定性心绞痛和糖尿病患者中，伊夫拉定是一种有吸引力的β受体阻滞剂的替代品。(C)2010 Elsevier Inc.保留所有权利。(美国心脏杂志2010；105：29-35)
Ivabradine is a specific heart rate-lowering antianginal agent that was evaluated in a clinical development program involving approximately 3,000 patients with stable coronary artery disease, most with angina pectoris. We analyzed the pharmacokinetics, efficacy (evaluated by exercise tolerance testing), safety, and effects on glucose metabolism of ivabradine in patients with diabetes mellitus (DM) in this program. Most analyses included data from 535 patients with DM, approximately 18% of the overall patient sample. Patients with DM were older, more likely to be women, and more likely to have more severe angina pectoris than patients without DM. The pharmacokinetics of ivabradine did not differ in patients with DM versus those without DM. A reduction in the heart rate at rest with ivabradine was similar in those with (15.2%) and without (15.7%) DM. At baseline, the exercise capacity tended to be lower in the patients with DM, but the improvements in most exercise tolerance measures with ivabradine treatment were similar in patients with and without DM. No special safety concerns were associated with ivabradine in those with DM. The rates of sinus bradycardia and visual disturbances, known to be related to the action of ivabradine, showed no relative increase in the patients with DM. Ivabradine treatment was not associated with adverse effects on glucose metabolism. In conclusion, ivabradine was effective in preventing angina in patients with DM and was not associated with particular safety concerns or adverse effects on glucose metabolism. Ivabradine represents an attractive alternative to beta blockers in patients with stable angina pectoris and DM. (C) 2010 Elsevier Inc. All rights reserved. (Am J Cardiol 2010;105:29-35)