ACE inhibitor reduces cardiac events in stable coronary disease
The long-acting angiotensin converting enzyme (ACE) inhibitor perindopril (Coversyl) reduces the risk of cardiovascular death and myocardial infarction by one-fifth in patients with stable coronary disease, according to the first major trial to investigate ACE inhibition in lower risk patients.
The EUROPA (European trial on reduction of cardiac events with perindopril
in stable coronary artery disease) study randomised 12,218 patients to
perindopril (8mg once daily) or placebo in addition to standard therapy,
with many patients also on platelet inhibitors, beta-blockers, lipid-lowering
therapy and nitrates.
Results after an average follow-up of 4.5 years reveal that perindopril
reduced the combined primary endpoint of cardiovascular death, myocardial
infarction and cardiac arrest by 20 per cent (P=0.00033). This was associated
with an 11 per cent reduction in overall mortality (not statistically
significant). Perindopril also reduced myocardial infarction (fatal or
nonfatal) by 24 per cent (P=0.001) and heart failure by 39 per cent (P=0.002).
Benefits were shared by all subgroups of patients, regardless of age,
and presence or absence of hypertension or diabetes.
Professor Kim Fox, co-chairman of the study and professor of clinical
cardiology at the Royal Brompton Hospital, London, said: “The results
of EUROPA represent a milestone in cardiology, proving for the first
time the life saving benefits of treatment with an ACE inhibitor, perindopril,
in this patient population.” He added: “ACE inhibition has
previously been shown to improve outcomes in patients with coronary disease
and heart failure and in high-risk patients with coronary artery disease,
with diabetes and hypertension.”
This left a big gap — patients with stable coronary artery disease,
with no additional risk factors. “We now know that they also benefit
from treatment with an ACE inhibitor. Perindopril should now be considered
for chronic therapy in all patients with coronary disease.”
Results show perindopril — even at the high dose used in the study — was
relatively well tolerated, with only 20 per cent of those on active treatment
withdrawing during the trial compared with 19 per cent of the placebo
group. ACE inhibition achieves two important benefits in patients with
coronary disease, with anti-atherosclerotic effects in addition to effective
blood pressure lowering, suggested Professor Fox.
Data from the trial were presented at the European
Society of Cardiology congress held in Vienna on 31 August and are published this week in The
Lancet (2003:362;782). |
