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European Heart Journal Advance Access originally published online on February 23, 2006
European Heart Journal 2006 27(7):796-801; doi:10.1093/eurheartj/ehi809
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© The European Society of Cardiology 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Treatment benefit by perindopril in patients with stable coronary artery disease at different levels of risk

Jaap W. Deckers1,*, Dick M. Goedhart2, Eric Boersma1, Andrew Briggs3, Michel Bertrand4, Roberto Ferrari5, Willem J. Remme6, Kim Fox7, Maarten L. Simoons1 on behalf of the EUROPA Investigators

1Department of Cardiology, Thoraxcenter, Erasmus University Medical Center Rotterdam, Room Ba 350, Dr Molewaterplein 40, 3015GD Rotterdam, The Netherlands
2Cardialysis, Rotterdam, The Netherlands
3University of Glasgow, Glasgow, UK
4Lille Heart Institute, Lille, France
5Azienda Ospedalier and University di Ferrara, Ferrara, Italy
6Sticares Cardiovascular Research Foundation, Rotterdam, The Netherlands
7Royal Brompton and National Heart Hospital, London, UK

Received 14 September 2005; revised 31 January 2006; accepted 3 February 2006; online publish-ahead-of-print 23 February 2006.

* Corresponding author. Tel: +31 10 463 5356; fax: +31 10 463 5513. E-mail address: j.deckers{at}erasmusmc.nl

Aims Patients with stable coronary artery disease (CAD) are at increased risk. Estimation of individual risk is difficult. We developed a cardiovascular risk model based on the EUROPA study population and investigated whether benefit of long-term administration of the angiotensin-converting enzyme (ACE)-inhibitor perindopril was modified by risk level.

Methods and results A total of 12 218 patients with stable CAD were treated with 8 mg perindopril or placebo. Baseline patient characteristics were assessed for association with 1091 cardiovascular deaths or non-fatal myocardial infarction (MI). Risk factors were age over 65 years, male gender [hazard ratio (HR) 1.2], previous MI (HR 1.5), previous stroke and/or peripheral vascular disease (HR 1.7), diabetes, smoking, angina (all HR 1.5), and high serum cholesterol and systolic blood pressure. Treatment benefit by perindopril was consistent among high, intermediate, and low risk patients (HRs 0.88, 0.68, and 0.83, respectively). Risk reduction was thus not modified by absolute risk level.

Conclusion Risk factors such as age, male gender, smoking, total cholesterol, and blood pressure continue to play an important role once clinical sequellae of coronary heart disease have developed. Patients at moderate-to-high risk because of uncontrolled risk factors and those with other indications for ACE-inhibitors have the most to gain from ACE-inhibition.

Key Words: Coronary artery disease • Prognosis • Risk stratification • ACE inhibitors


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