Transcript EUROPA
Clinical implications Burden of coronary disease 56 millions deaths worldwide in 2001 29% due to CV disease (~ 16 millions) (37% are foreseen in 2020) 20 millions of people in the EU have coronary disease Clinical expression of coronary disease Unstable angina Stable Angina MI Coronary Disease Silent ischemia Heart failure Sudden death Benefit of ACE inhibition % Perindopril Placebo 9.9 8.0 6.8 6.1 5.2 3.5 6.9 4.1 0.1 CV death, MI CV death Card. arrest MI 0.2 Card.arrest Death Absolute benefits Perindopril 8 mg once a day prevents one cardiovascular death, non fatal MI or cardiac arrest among every 50 patients with coronary disease treated for 4 years For a country of 60 million inhabitants, this means that perindopril over a 4 year period will stop 50 000 heart attacks or CV deaths % Death, MI, Cardiac arrest 15.2 % 12.7 8.1 5.2 6.2 Low 6.2 Medium High risk Age, gender, previous MI, previous CABG/PCI, PVD or stroke, hypertension, diabetes, smoking, hyperchol., lipid lowering, -blockers. Myocardial infarction 64% of patients had an history of MI 20% within 1 year of the MI 47% between 1 and 5 years after MI 33% more than 5 years after MI Sub-groups analysis Perindopril better Placebo better RRR (%) Lipid lowering drug 16.3 No lipid lowering drug 22.3 -blockers 26.4 No -blockers 7.0 Calcium blockers 15.8 No calcium blockers 22.2 0.5 92% patients on platelet inhibitors 1.0 2.0 Interaction A formal interaction analysis was performed for the effect of perindopril in relation to: -blockers Lipid lowering drugs Calcium antagonists Interaction effect was not significant in all 3 analyses The treatment effect of perindopril was independent of the other drugs HOPE vs. EUROPA Study population HOPE EUROPA Age (yrs) 66 60 Female gender (%) 27 15 Known CAD (%) 80 100 Previous MI (%) 53 65 PVD (%) 43 7 Stroke/TIA (%) 11 3 Diabetes (%) 38 12 Hypertension (%) 47 27 Hypercholesterolemia (%) 66 63 HOPE vs. EUROPA Baseline HOPE EUROPA Antiplatelet drugs* 76 % 92 % -blockers 39 % 62 % Lipid lowering drugs 29 % 58 % More extensive treatment in EUROPA than in HOPE * Mostly aspirin HOPE vs. EUROPA Placebo outcomes standardised for 4.5 yrs FU HOPE EUROPA Total mortality 12.2% 7.4 % CV mortality 8.1% 4.4% Q wave MI 3.2% 2.1% Major annual event rates : 50 to 80 % higher in HOPE Benefits for all coronary artery disease patients SOLVD SAVE AIRE TRACE SOLVD (prev) HOPE EUROPA ALL CAD PATIENTS Summary of results In EUROPA, the largest and longest trial of stable, optimally treated CAD patients, perindopril 8 mg/d significantly reduced: CV mortality + non fatal MI + cardiac arrest: 20% CV mortality and non fatal MI: 19% Fatal + non fatal MI: 24% Heart failure: 39% Benefits of results Benefits occurred on top of recommended therapy (92% platelet inhibitors, 58% lipid lowering drugs, 62% -blockers) and are consistent across predefined sub-groups Perindopril should be considered for chronic therapy in all patients with coronary disease