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 patients’ lifestyle, 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.

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