The EUROPA study has been designed to determine the benefits of the long-acting ACE inhibitor perindopril when added to existing medication(s) in patients with stable coronary artery disease.
Perindopril has extensive clinical data in the management of a variety
of cardiovascular (CV) diseases, including hypertension, heart failure
and post myocardial infarction (MI). Data also exist to show that perindopril
may have specific benefits in patients with stable coronary artery disease.
However, the long-term efficacy of ACE inhibitors in all patients with
stable coronary artery disease has never been investigated or established.
Due to this lack of existing evidence, there was a strong need for a study
such as EUROPA to establish the long-term benefits of perindopril in this
group of patients.
The EUROPA study is in fact the first trial to assess the long-term effects
(over four years) of ACE inhibition with perindopril on the reduction
of cardiac events in all patients with proven stable coronary artery disease
with/without signs of myocardial ischaemia, but without heart failure,
irrespective of age, CV risk profile or ventricular function.
Why is coronary artery disease such an important issue?
Cardiovascular disease is a major worldwide health problem – of an estimated
56 million deaths worldwide in 2001, more than 29% were due to cardiovascular
disease (World Health Report 2002). Significantly, coronary artery disease
is the most common manifestation of cardiovascular disease and is consequently
one of the principal causes of death worldwide.
The standards of medical care have improved dramatically over the past
three decades. However, despite modifications in
the use of newer medications and improved surgical
techniques, coronary artery disease remains one of the leading causes
of death worldwide. Furthermore,
this disease burden will continue to escalate and
projections estimate that, by 2020, at least 37% of all deaths will be
due to cardiovascular
causes (Murray C, WHO 1996).
The considerable potential of EUROPA
The EUROPA study is the first of its kind to exclusively examine
patients with stable coronary artery disease with/without signs of myocardial
ischaemia, but without heart failure, irrespective of age, CV risk profile
or ventricular function. Therefore, the study results with perindopril 8 mg
will have long term, far-reaching consequences in clinical practice. If perindopril
is shown to have significant beneficial effects in this patient population
(12,218 patients recruited) then it may offer the clinician new opportunities
in the management of all patients with stable coronary artery disease irrespective
of their risk profile or their existing medication(s) with preventative benefits
in all patients with cardiovascular disease.