Abstract
BEAUTIFUL trial investigated the effect on cardiovascular outcomes of the If inhibitor ivabradine in nearly 11 000 patients with coronary artery disease and left ventricular dysfunction. The only pharmacological effect of ivabradine is a heart rate reduction, and BEAUTIFUL was thus the first study to directly evaluate the effect of slowing heart rate on cardiovascular risk.
Results of the study are negative: ivabradine failed to demonstrate the reduction of the primary composite endpoint or any of its components, and there was not even a trend towards improvement to suggest any beneficial effect of the treatment. Based on these results, a pure heart rate reduction appears unlikely to be beneficial in majority of patients with cardiovascular disease.