Abstract 18906: Combining Perindopril With a Calcium Channel Blocker and a Lipid Lowering Agent Significantly Decreases Mortality: A Subgroup Analysis of Europa
Background: Management of patients with stable ischemic heart disease (IHD), in addition to heart rate control and antiplatelet therapy, relies on the administration of blood pressure lowering therapies and lipid normalization. However, the ACTION trial revealed that a strategy with a calcium channel blocker (CCB) and a lipid lowering therapy (LLT) alone, on top of conventional care, was not sufficient to provide further protection regarding cardiovascular events and death. Since a medical need remains for CCB, mainly in case of angina, we investigated if, as globally recommended by current guidelines for IHD patients, the addition of an ACE inhibitor would provide additional benefit in this specific population.
Methods: The EUROPA trial evaluated the cardioprotective effect of perindopril in a low-risk population with coronary artery disease but no signs of heart failure for a mean follow-up of 4.2 years (75% of class I, 21% with class II, 3% Class III and 1% class IV angina status). The database was reanalyzed to compare the benefit of the addition of perindopril or placebo in patients receiving a CCB/LLT strategy at baseline and all along the trial (1056 patients).
Results: Patients receiving perindopril on top of a CCB and a LLT displayed a significant 46% relative reduction of the primary endpoint (p=0.023), a composite of cardiovascular death, myocardial infarction and cardiac arrest, compared to those only having CCB/LLT. In addition, the triple combination allowed relative risk reductions of respectively 58% (p=0.027) and 71% (p=0.028) for all-cause and cardiovascular mortality. Non-significant decreases in myocardial infarction (28%) and heart failure (41%) seemed to support at least partly the positive impact on mortality.
Conclusion: The addition of an ACE inhibitor to a CCB/LLT strategy clearly demonstrated a reduction of mortality in this post-hoc analysis of EUROPA and confirmed results previously obtained in high-risk hypertensive patients in the ASCOT study.
- © 2013 by American Heart Association, Inc.