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Clinical implications

Clinical implications. Burden of coronary disease. 56 millions deaths worldwide in 2001 29% due to CV disease (~ 16 millions) (37% are foreseen in 2020) 20 millions of people in the EU have coronary disease. Clinical expression of coronary disease. Unstable angina. MI.

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Clinical implications

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  1. Clinical implications

  2. Burden of coronary disease • 56 millions deaths worldwide in 2001 • 29% due to CV disease (~ 16 millions) (37% are foreseen in 2020) • 20 millions of people in the EU have coronary disease

  3. Clinical expression of coronary disease Unstable angina MI Coronary Disease Stable Angina Heart failure Sudden death Silent ischemia

  4. Benefit of ACE inhibition Perindopril % Placebo 9.9 8.0 6.9 6.8 6.1 5.2 4.1 3.5 0.2 0.1 CV death, MI Card. arrest CV death MI Card.arrest Death

  5. Absolute benefits Perindopril 8 mg once a day preventsone cardiovascular death, non fatal MI or cardiac arrest among every 50patients with coronary disease treated for 4 years For a country of 60 million inhabitants, this means that perindopril over a 4 year period will stop 50 000 heart attacks or CV deaths

  6. % Death, MI, Cardiac arrest % 15.2 12.7 8.1 6.2 6.2 5.2 Low Medium High risk Age, gender, previous MI, previous CABG/PCI, PVD or stroke, hypertension, diabetes, smoking, hyperchol., lipid lowering, -blockers.

  7. Myocardial infarction 64% of patients had an history of MI • 20% within 1 year of the MI • 47% between 1 and 5 years after MI • 33% more than 5 years after MI

  8. Perindoprilbetter Placebobetter RRR (%) Lipid lowering drug 16.3 No lipid lowering drug 22.3 -blockers 26.4 No -blockers 7.0 Calcium blockers 15.8 No calcium blockers 22.2 0.5 1.0 2.0 Sub-groups analysis 92% patients on platelet inhibitors

  9. Interaction A formal interaction analysis was performed for the effect of perindopril in relation to: • -blockers • Lipid lowering drugs • Calcium antagonists Interaction effect was not significant in all 3 analyses The treatment effect of perindopril was independent of the other drugs

  10. HOPE vs. EUROPA

  11. HOPE vs. EUROPA More extensive treatment in EUROPA than in HOPE * Mostly aspirin

  12. HOPE vs. EUROPA Placebo outcomes standardised for 4.5 yrs FU Major annual event rates : 50 to 80 % higher in HOPE

  13. SOLVD (prev) HOPE EUROPA Benefits for all coronary artery disease patients SOLVD SAVE AIRE TRACE ALL CAD PATIENTS

  14. Summary of results In EUROPA, the largest and longest trial of stable,optimally treated CAD patients, perindopril 8 mg/dsignificantly reduced: • CV mortality + non fatal MI + cardiac arrest:20% • CV mortality and non fatal MI:19% • Fatal + non fatal MI:24% • Heart failure:39%

  15. Benefits of results • Benefits occurred on top of recommended therapy (92% platelet inhibitors, 58% lipid lowering drugs, 62% -blockers) and are consistent across predefined sub-groups • Perindopril should be considered for chronic therapy in all patients with coronary disease

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