|
Efficacy of
perindopril in reduction of cardiovascular events among patients with
stable coronary artery disease: randomised, double-blind,
placebo-controlled, multicentre trial (the EUROPA study)
Fox KM
Cardiology Department of Royal Brompton Hospital, London, UK |
|
BACKGROUND: Treatment with angiotensin-converting-enzyme
(ACE) inhibitors reduces the rate of cardiovascular events among
patients with left-ventricular dysfunction and those at high risk of
such events. We assessed whether the ACE inhibitor perindopril reduced
cardiovascular risk in a low-risk population with stable coronary heart
disease and no apparent heart failure.
METHODS: We recruited patients from October, 1997, to June, 2000. 13655
patients were registered with previous myocardial infarction (64%),
angiographic evidence of coronary artery disease (61%), coronary
revascularisation (55%), or a positive stress test only (5%). After a
run-in period of 4 weeks, in which all patients received perindopril,
12218 patients were randomly assigned perindopril 8 mg once daily
(n=6110), or matching placebo (n=6108). The mean follow-up was 4.2
years, and the primary endpoint was cardiovascular death, myocardial
infarction, or cardiac arrest. Analysis was by intention to treat.
FINDINGS: Mean age of patients was 60 years (SD 9), 85% were male, 92%
were taking platelet inhibitors, 62% beta blockers, and 58%
lipid-lowering therapy. 603 (10%) placebo and 488 (8%) perindopril
patients experienced the primary endpoint, which yields a 20% relative
risk reduction (95% CI 9-29, p=0.0003) with perindopril. These benefits
were consistent in all predefined subgroups and secondary endpoints.
Perindopril was well tolerated.
INTERPRETATION: Among patients with stable coronary heart disease
without apparent heart failure, perindopril can significantly improve
outcome. About 50 patients need to be treated for a period of 4 years to
prevent one major cardiovascular event. Treatment with perindopril, on
top of other preventive medications, should be considered in all
patients with coronary heart disease. |