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Perindopril and β-blocker for the prevention of cardiac events and mortality in stable coronary artery disease patients: A EUropean trial on Reduction Of cardiac events with Perindopril in stable coronary Artery disease (EUROPA) subanalysis.

AbstractBACKGROUND:
β-Blockers relieve angina/ischemia in stable coronary artery disease (CAD), and angiotensin-converting enzyme inhibitors prevent CAD outcomes. In EUROPA, the angiotensin-converting enzyme inhibitor perindopril reduced cardiovascular outcomes in low-risk stable CAD patients over 4.2 years. This post hoc analysis examined whether the addition of perindopril to β-blocker in EUROPA had additional benefits on outcomes compared with standard therapy including β-blocker.
METHODS:
EUROPA was a multicenter, double-blind, placebo-controlled, randomized trial in patients with documented stable CAD. Randomized EUROPA patients who received β-blocker at baseline were identified, and the effect on cardiovascular outcomes of adding perindopril or placebo was analyzed. Endpoints were the same as those in EUROPA.
RESULTS:
At baseline, 62% (n = 7534 [3789 on perindopril and 3745 on placebo]) received β-blocker. Treatment with perindopril/β-blocker reduced the relative risk of the primary end point (cardiovascular death, nonfatal myocardial infarction, and resuscitated cardiac arrest) by 24% compared with placebo/β-blocker (HR, 0.76; 95% CI, 0.64-0.91; P = .002). Addition of perindopril also reduced fatal or nonfatal myocardial infarction by 28% (HR, 0.72; 95% CI, 0.59-0.88; P = .001) and hospitalization for heart failure by 45% (HR, 0.55; 95% CI, 0.33-0.93; P = .025). Serious adverse drug reactions were rare in both groups, and cardiovascular death and hospitalizations occurred less often with perindopril/β-blocker.
CONCLUSIONS:
The addition of perindopril to β-blocker in stable CAD patients was safe and resulted in reductions in cardiovascular outcomes and mortality compared with standard therapy including β-blocker.
AuthorsMichel E Bertrand, Roberto Ferrari, Willem J Remme, Maarten L Simoons, Kim M Fox
JournalAmerican heart journal (Am Heart J) Vol. 170 Issue 6 Pg. 1092-8 (Dec 2015) ISSN: 1097-6744 [Electronic] United States
PMID26678630 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
CopyrightCopyright © 2015 Elsevier Inc. All rights reserved.
Chemical References
  • Adrenergic beta-Antagonists
  • Angiotensin-Converting Enzyme Inhibitors
  • Perindopril
Topics
  • Adrenergic beta-Antagonists (administration & dosage, adverse effects)
  • Aged
  • Angiotensin-Converting Enzyme Inhibitors (administration & dosage, adverse effects)
  • Coronary Artery Disease (diagnosis, drug therapy, mortality)
  • Double-Blind Method
  • Europe (epidemiology)
  • Female
  • Hospitalization (statistics & numerical data)
  • Humans
  • Male
  • Middle Aged
  • Outcome and Process Assessment, Health Care
  • Patient Acuity
  • Perindopril (administration & dosage, adverse effects)
  • Survival Analysis
  • Treatment Outcome

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