We undertook a systematic review of the HOPE, EUROPA and PEACE trials to determine the consistency with which ACE-inhibitors reduce fatal and non-fatal cardiovascular events, and to explore whether benefits varied between patients with varying levels of risk or by ancillary treatments.
There was consistency on different outcomes between the 3 trials. ACE inhibitors reduced the composite outcomes of cardiovascular mortality, non-fatal myocardial infarction or stroke [10.7% (1599/14913) v 12.8% (1910/14892) p< 0.0001] as well as (all P < 0.001) all-cause mortality (7.8 v 8.9%), cardiovascular mortality ( 4.3% v 5.2%), non-fatal myocardial infarction (5.3 v 6.4%), all stroke (2.2 v 2.8%) , heart failure (HF) (2.1 v 2.7%), coronary artery bypass surgery (6.0 v 6.9%, p = 0.0036) but not percutaneous coronary intervention (7.4 v 7.6%, p = 0.481). Except for stroke and revascularization, these results were similar to those of the 5 trials in patients with HF or LVSD.
The odds reduction (OR) for the composite outcomes varies between 15 to 30% for the different trials irrespective of their annual rates of events in the placebo groups except for PEACE that had a 7% OR reduction for a 2.13% event rate. This last finding suggests that there may be a threshold beyond which ACE inhibitors have no benefits in low-risk CAD patients. However, this possibility was not confirmed with low-risk patients from HOPE and EUROPA (Fig.1). The benefits of the ACE inhibitors were observed among combined EUROPA and HOPE patients taking betablockers, lipid lowering agents and antiplatelets individually or together, and/or having undergone coronary revascularization (Fig. 2).
The benefits of ACE inhibitors are consistent, observed in addition to other proven therapies, and even in low-risk CAD patients. Therefore, ACE inhibitors should be considered in all patients with vascular disease as long as they can tolerate these agents and the absolute benefits are judged to be worthy.
Slide presentation [Available]
We undertook a systematic review of the HOPE, EUROPA and PEACE trials to determine the consistency with which ACE-inhibitors reduce fatal and non-fatal cardiovascular events, and to explore whether benefits varied between patients with varying levels of risk or by ancillary treatments.
There was consistency on different outcomes between the 3 trials. ACE inhibitors reduced the composite outcomes of cardiovascular mortality, non-fatal myocardial infarction or stroke [10.7% (1599/14913) v 12.8% (1910/14892) p< 0.0001] as well as (all P < 0.001) all-cause mortality (7.8 v 8.9%), cardiovascular mortality ( 4.3% v 5.2%), non-fatal myocardial infarction (5.3 v 6.4%), all stroke (2.2 v 2.8%) , heart failure (HF) (2.1 v 2.7%), coronary artery bypass surgery (6.0 v 6.9%, p = 0.0036) but not percutaneous coronary intervention (7.4 v 7.6%, p = 0.481). Except for stroke and revascularization, these results were similar to those of the 5 trials in patients with HF or LVSD.
The odds reduction (OR) for the composite outcomes varies between 15 to 30% for the different trials irrespective of their annual rates of events in the placebo groups except for PEACE that had a 7% OR reduction for a 2.13% event rate. This last finding suggests that there may be a threshold beyond which ACE inhibitors have no benefits in low-risk CAD patients. However, this possibility was not confirmed with low-risk patients from HOPE and EUROPA (Fig.1). The benefits of the ACE inhibitors were observed among combined EUROPA and HOPE patients taking betablockers, lipid lowering agents and antiplatelets individually or together, and/or having undergone coronary revascularization (Fig. 2).
The benefits of ACE inhibitors are consistent, observed in addition to other proven therapies, and even in low-risk CAD patients. Therefore, ACE inhibitors should be considered in all patients with vascular disease as long as they can tolerate these agents and the absolute benefits are judged to be worthy.
Slide presentation [Available]
Session Number : 710011
Session Title: Clinical Trial Update I