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Treatment benefit by perindopril in patients with stable coronary artery disease at different levels of risk
Authors:
J W Deckers, DM Goedhart, ME Bertrand1, R Ferrari2, K Fox3, WJ Remme4, ML Simoons, Erasmus MC - Rotterdam - Netherlands, 1University of Lille - Lille - France, 2University of Ferrara - Ferrara - Italy, 3Royal Brompton Hospital - London - United Kingdom, 4Sticares Cardiovascul Res Foundation - Rotterdam - Netherlands,
Topic(s):
ACE inhibitors and AT2 blockers
Epidemiology / prevention, other
Prognosis, risk assessment
Adjunctive medical therapy
Patients with stable coronary artery disease (CAD) are at increased risk for recurrent cardiac events. However, estimation of individual risk is difficult, and assessment of absolute treatment benefit thus complex.
For these reasons, we developed a cardiovascular risk model, and investigated whether benefit associated with long-term administration of the ACE inhibitor perindopril was modified by risk level.
Study population: 12.218 patients (age range 26 to 86 years) with stable CAD (no heart failure or hypertension) treated with 8 mg perindopril or placebo.
Baseline patient characteristics were assessed for association with 1.090 cardiovascular deaths or non-fatal MI accruing over 50.000 years of follow-up.
Major risk factors: age over 65 years, male gender (RR 1,2), previous MI (RR 1,4), previous stroke or PVD (RR 2,0), diabetes (1,8), smoking (1,4), angina (RR 1,7), elevated serum cholesterol and systolic BP. Risk was reduced in patients with previous revascularization and on lipid lowering therapy (both RR 0,7).
Patients were categorized in tertiles (approximately 4.000 patients each) of modeled risk. Results are given in the table.
Conclusions: Treatment benefit by perindopril was consistent (risk reduction 20%) among high, intermediate and low risk patients. Reduction of risk was thus not modified by absolute level of risk.
Risk tertile |
Perindopril |
Placebo |
Risk Reduction |
1 |
4,3% |
5,0% |
15% |
2 |
6,3% |
9,4% |
34% |
3 |
13,5% |
15,2% |
11% |
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