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Heart drug shows promiseBupa investigative news - 8 September 2003 Coronary artery disease is the most common form of heart disease, and is one of the major causes of death worldwide. A huge study called the EUROPA project, involving more than 12,000 patients from 24 European countries, has discovered that the use of an existing drug alongside current treatments could offer significant benefits for sufferers, reducing the risk of heart attacks and death. But how important are the findings, what is the drug and how soon will it be before people can benefit? What were the headlines?A flurry of heart-related news made the headlines alongside details of research being presented at the European Society of Cardiology Congress in Vienna. One particular drug trial, involving the ACE inhibitor perindopril, was featured in various newspapers and online media publications. The reports gained headlines such as "Pressure drug cuts heart deaths", "Researchers call for wider use of ACE heart drugs", "Blood pressure drug shown to help heart patients", and "Heart pill 'cuts risk'". What is the bigger picture?The EUROPA (European trial on Reduction Of cardiac events with Perindopril in stable coronary Artery disease) study involved 12,218 patients from 24 European countries and is believed to be the largest ever study carried out in patients with stable coronary disease. Patients were randomly assigned 8mg of perindopril once daily, or a placebo, in addition to their existing medication (such as beta blockers, aspirin and statins). Perindopril is a type of ACE (angiotensin converting enzyme) inhibitor drug. These drugs work by blocking the production of a protein called angiotensin II, which makes the blood vessels constrict, thus lowering blood pressure. The patients were seen by doctors at regular intervals and followed up for an average of four years. The findings showed that fewer patients given perindopril died from cardiovascular causes or had heart attacks compared with those given the placebo drugs. In fact, the risk of death was cut by 11 per cent, there was a 24 per cent reduction in heart attacks and a 39 per cent reduction in heart failure. Details of the study were presented at the European Society of Cardiology (ESC) Congress in Vienna and published in The Lancet medical journal. According to study co-chairman, Professor Kim Fox, from the Royal Brompton Hospital in London, "The results of EUROPA represent a milestone in cardiology, proving for the very first time the life-saving benefits of an ACE inhibitor, perindopril, in this patient population." "This is a major step forward and will have important implications in the future management of coronary disease. Coronary disease is the most common type of heart disease and accounts for almost one third of all deaths, which is approximately 16 million deaths every year worldwide," he added. His co-chairman, Professor Willem Remme, from Sticares Cardiovascular Research Institute in The Netherlands, said, "For the first time we have a drug that not only treats hypertension, an important cardiovascular risk factor, but also improves the outcome of patients with coronary disease. We now have sufficient evidence to show that perindopril, beyond its blood-pressure lowering effect has additional advantages and should be used to treat all patients with angina pectoris, history of heart attacks and other evidence of coronary disease, regardless of their hypertensive status." "Coronary disease represents a major and growing public health problem worldwide," the two co-chairmen concluded. "It is our duty to improve life expectancy and quality of life. The EUROPA results have now confirmed the life-saving benefits of perindopril in coronary disease patients properly treated with preventive medications. Optimal preventive treatment should include perindopril." For heart failure patients who aren't able to take ACE inhibitors, another heart drug also mentioned at the ESC meeting and in The Lancet could offer help. The drug, called candesartan is an angiotensin receptor blocker (ARB) and it was found to cut deaths and the need for hospital admissions by up to 23 per cent.
What does this mean?Professor Alistair Hall, a cardiologist from the British Heart Foundation Heart Research Centre in Leeds, described the findings as "exciting" and the data as "impressive". "Perindopril has already been used in two heart conditions - one is blood pressure, the other heart failure. What EUROPA has done is look at the use with coronary artery disease, or furring of the heart arteries (which all of us have to some degree, but when it gets more severe it causes angina or heart attacks). Everyone in this study had evidence clinically of some heart artery furring, but they were relatively low risk compared to the sorts of people who've been studied before with these types of drug," he explained. "What the study showed was that if you give perindopril, as opposed to not giving it, over a four-year period, the chances of having a heart attack with or without dying from it is reduced by 20 per cent." He added that, "The risk was reduced even more markedly in younger people under 55 years old," something he regards as a "very valuable aspect of this study". Put into perspective, this means that, "These benefits are increasing all the way up to four years and would be expected to increase beyond that," he said. "So if you're talking about a 50-year-old person taking this drug for 10 years, then the benefits would be even more significant. Even with four years one is probably delaying death or heart attack by about a year, which is a definite benefit." Dr. John Pittard, a GP from Middlesex who also practices at Chertsey, Surrey, said, "It's almost certainly one of the better landmark trials of recent years. It pretty much suggests that anyone with any evidence of coronary artery disease should be considered for the ACE inhibitor perindopril. A lot of other studies have hinted at that, but it's never been completely proven."
What does this mean to me?For people affected by coronary artery disease, the drug could have a significant effect. "Pretty much everybody with evidence of coronary artery disease could have great benefits - a 24 per cent lower risk of heart attacks and a 20 per cent lower risk of death," said Dr. Pittard. However, Professor Hall admits that a "development like this does take time to become implemented," so doctors might not instantly be prescribing the drug for this purpose. He suggests patients can play a role in helping their doctors become aware of the information though, and suggests that, "If you're someone who'd be eligible and helped by this you should be in a position to go to your doctor, mention you've read about the research and say, 'How about me?'" With 30,000 people under the age of 65 years old dying of a heart attack every year, Professor Hall was keen to emphasise the importance of regular check-ups. He said they're extremely worthwhile and can highlight any potential problems and give the opportunity for treatment to start early. Although partly caused by the natural ageing process, lifestyle aspects that can increase the risk of coronary artery disease include smoking, obesity and a sedentary lifestyle. SummaryFor sufferers of coronary artery disease, the news that an existing drug could offer help in conjunction with current treatment is encouraging. Hopefully it won't be too long before people can gain benefits from this discovery. Links for more information
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