The angiotensin-converting enzyme inhibitor perindopril may lower risk for cardiovascular morbidity and mortality in all patients with coronary heart disease, both those considered at high risk and those considered at low risk, according to a study presented at the European Society of Cardiology and published online by the Lancet. The researchers found that the effect of perindopril was additive to those of other well-known therapies such as aspirin, beta blockers, and statins.

The European trial on reduction of cardiac events with perindopril in patients with stable coronary artery disease (the EUROPA study) assessed whether the angiotensin-converting enzyme inhibitor perindopril reduced cardiovascular risk in a low-risk population. Over 12,000 patients from several European countries with coronary artery disease (65 percent of whom had had previous myocardial infarction, 61 percent of whom had angiographically proven coronary artery disease, 55 percent of whom had coronary revascularization) were randomized to perindopril 8 mg daily or placebo and followed for an average of just over 4 years.

Myocardial infarction and cardiovascular mortality rates were lower (488 patients, 8 percent) in patients given perindopril than in those given placebo (603, 10 percent). Of the total number of patients, 92 percent were taking a platelet inhibitor, 62 percent were taking a beta blocker, and 58 percent were on some form of lipid-lowering therapy.

Study Cochairman Dr. Kim Fox commented, "Among patients with stable coronary heart disease without apparent heart failure, perindopril can significantly improve outcome. About 50 patients need to be treated for a period of 4 years to prevent 1 major cardiovascular event. Treatment with perindopril, on top of other preventive medications, should be considered in all patients with coronary heart disease."