The long-acting ACE inhibitor perindopril (Coversyl) significantly reduces the risk of cardiovascular death and heart attacks in patients with stable coronary disease which includes patients with angina and or a previous heart attack, according to results from the landmark EUROPA study (EUropean trial on Reduction Of cardiac events with Perindopril in stable coronary Artery disease).
EUROPA is the largest study ever conducted in patients with stable coronary disease. The study involved 12,218 patients from 24 European countries. Patients were randomised to Coversyl once daily or placebo, in addition to optimal therapy, for an average of four years.
Coversyl reduced the combined primary endpoint of cardiovascular death, myocardial infarction and cardiac arrest by 20% (p=0.0003). This was associated with an 11% reduction in total death. In addition, perindopril reduced myocardial infarction (fatal or non-fatal) by 24% (p<0.001) and heart failure by 39% (p=0.002). Benefits were present in all patient groups with or without hypertension, diabetes and irrespective of age.
EUROPA is the first study to demonstrate the efficacy and safety of ACE inhibition in a broad spectrum of patients with stable coronary disease. The study involved coronary disease patients commonly seen in clinical practice, optimally treated with other preventive therapy (aspirin, statins and beta-blockers).
“This is a major step forward and will have important implications in the future management of coronary disease,” said Dr. Eric Borges, Consultant Cardiologist, Bombay Hospital & Research Centre, Mumbai. “Coronary disease is the most common type of heart disease and accounts for almost one third of all deaths, which is approximately 16 million deaths every year worldwide”.
“For the first time we have a drug that not only treats hypertension, an important cardiovascular risk factor, but also improves the outcome of patients with coronary disease. We now have sufficient evidence to show that perindopril, beyond its blood-pressure lowering effect has additional advantages and should be used to treat many, if not all, patients with angina pectoris, history of heart attacks and other evidence of coronary disease, regardless of their hypertensive status,” added Dr Borges.
“Coronary disease represents a major and growing public health problem worldwide, including India. The results of EUROPA represent a milestone in cardiology, proving for the very first time, the life saving benefits of an ACE inhibitor, perindopril, in this patient population. Perindopril added to standard optimal therapy over a four year period could prevent heart attacks or cardiovascular deaths,” he added.
The long-acting ACE inhibitor Coversyl, once daily, was chosen for the EUROPA study based on its 24-hour efficacy, including blood-pressure control, its documented cardiovascular anti-ischaemic and anti-atherogenic properties, and also because it is easy to use and well tolerated.
Perindopril has well-documented efficacy in the treatment of cardiovascular diseases, including hypertension, heart failure and more recently, with the results of PROGRESS (Perindopril Protection Against Recurrent Stroke Study), in cerebrovascular disease. The results of EUROPA demonstrate the benefits of perindopril for the treatment of patients with stable coronary disease.