Source: DGNews  |  Posted 3 years ago

By Lexa W. Lee

NEW ORLEANS -- November 12, 2008 -- Use of the angiotensin-converting enzyme inhibitor perindopril reduced the number of cardiovascular events by 11% to 18% compared with placebo in patients with vascular disease or at high risk of developing vascular disease, according to results presented here at the American Heart Association (AHA) Scientific Sessions.

Lead author Jasper Brugts, MD, Erasmus Medical Centre, Rotterdam, the Netherlands, presented the results of this analysis on November 11.

The efficacy of perindopril has been demonstrated previously in 3 large placebo-controlled clinical trials in patients with stable coronary artery disease without overt heart failure, patients with a history of stroke or transient ischaemic attack, and patients with type 2 diabetes, Dr. Brugts said.

The researchers of the present study wanted to determine the effects of perindopril on a more general level by pooling the data from these studies: the European Trial on Reduction of Cardiac Events With Perindopril in Stable Coronary Artery Disease (EUROPA), Perindopril Protection Against Recurrent Stroke Study (PROGRESS), and Action in Diabetes and Vascular Disease (ADVANCE).

In EUROPA, the treatment effect of perindopril 8 mg was assessed during a mean follow-up of 4.2 years; in PROGRESS, perindopril 4 mg combined with indapamide was evaluated during 4 years of follow-up. In ADVANCE, addition of perindopril/indapamide was evaluated during 4.3 years of follow-up in patients already receiving standard treatment, including other drugs to lower blood pressure.

Mean blood pressure reductions in the 3 trials were (systolic/diastolic) 5/2, 9/4, and 6/2 mm Hg, respectively.

Perindopril significantly reduced major cardiovascular events in all the trials, independent of baseline blood pressure.

The shared endpoints of the trials were all-cause mortality and cardiovascular mortality plus myocardial infarction. Dr. Brugts and colleagues used a meta-analysis design to evaluate the combined treatment effect.

According to the findings in a total of 29,493 patients, perindopril significantly reduced risk of all-cause mortality (odds ratio [OR] 0.89; 95% confidence interval [CI], 0.82-0.97) as well as cardiovascular mortality plus myocardial infarction (OR 0.82; 95% CI, 0.74-0.90).

The combined analysis showed that perindopril reduced cardiovascular events by 11% to 18% compared with placebo.

This reduction in the number of cardiovascular events is consistent among all patients with vascular disease, including those at a high risk of developing vascular disease.

[Presentation title: The Treatment Effect of Perindopril Is Consistent in All Patients With Vascular Disease or High Risk of Vascular Disease: A Combined Analysis of Three Perindopril Trials. Presentation 5066]