If this is not your name, click here.
| | If this is not your name, click here. | | |
| | Contact Us | Order Now | Journals | Bookstore | Register a colleague | | |
| |  Perindopril Has Synergistic Effect With Calcium Channel Blockers in Prevention of Cardiac Events and Death in Patients With Coronary Artery Disease: Presented at ESC By Chris Berrie MUNICH, Germany -- September 5, 2008 -- Addition of the angiotensin-converting enzyme (ACE) inhibitor perindopril to calcium channel blocker (CCB) therapy shows a clinical interaction for reduction of total mortality and major coronary events in patients with stable coronary artery disease (CAD), according to results of a post hoc analysis of a randomised, double-blind, placebo-controlled study. Michel Bertrand, MD, Lille Heart Institute and University of Lille, Lille, France, presented the study findings here at the European Society of Cardiology 2008 Congress (ESC) on behalf of the European Trial on the Reduction of Cardiac Events With Perindopril in Stable Coronary Artery Disease (EUROPA). The aim of the study was to investigate potential synergistic effects between perindopril and CCBs through an analysis of the EUROPA trial data, Dr. Bertrand said in his presentation on September 2. The EUROPA trial involved randomisation of 6,108 patients with stable CAD to placebo and 6,110 to perindopril 8 mg/day. Within each treatment arm, patients either did or did not take a CCB. With this study design, 1,100 patients received placebo plus CCB and 1,022 received perindopril plus CCB. These patients were a mean of 61.8 and 61.4 years old, respectively, and men made up 84.2% and 82.4% of the groups, respectively. Demographic and medication data, as well as CAD and medical histories, were well balanced across these 2 groups. For the primary endpoint, combined cardiovascular death, nonfatal myocardial infarction (MI), and resuscitated cardiac arrest reached a significant 35% reduction in relative risk for perindopril plus CCB versus CCB alone (hazard ratio [HR], 0.645; P = .0147). For the synergy analysis, Dr. Bertrand said, "Synergy was considered if the hazard ratio of perindopril plus a calcium channel blocker was lower than the hazard ratio of perindopril alone multiplied by the hazard ratio of the calcium channel blocker alone, a traditional method for statistics." Once the data were fully adjusted for a number of covariants, for the primary endpoint, the HR for the combined treatment was lower than that of the product of the 2 treatments alone (0.50 vs 0.64, respectively). Similarly, the same effect was seen for the HRs of each secondary endpoint: total mortality (0.31 vs 0.52, respectively), cardiovascular mortality (0.29 vs 0.36), fatal and nonfatal MI (0.68 vs 0.75), and hospitalisation for heart failure (0.14 vs 0.18). "These data show that possibly there is a synergistic effect of the perindopril and calcium channel blockers on these endpoints," Dr. Bertrand added. He noted that the types and doses of the CCBs remain unknown, although he speculated that "the absence of differences in heart rate between the subgroups taking and not taking a CCB suggests that the CCBs were possibly mainly dihydropyridines." "This clinical interaction between perindopril and CCBs that suggests synergistic effects of course merits further investigation," he added. Funding for this study was provided by Servier. [Presentation title: Synergistic Effect of Perindopril and Calcium Channel Blockers in Prevention of Cardiac Events and Death in Coronary Artery Disease Patients -- Analysis From the EUROPA Study. Abstract 3267]
|
