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The consistency of the treatment effect of an ACE-inhibitor based treatment regimen in patients with vascular disease or high risk of vascular disease: a combined analysis of individual data of ADVANCE, EUROPA, and PROGRESS trials.
Eur Heart J 2009; 30(11):1385-94EH

Abstract

AIMS

Angiotensin-converting enzyme (ACE) inhibitors have been shown to reduce cardiovascular risk in different groups of patients. Whether these effects can be generalized to the broad group of patients with vascular disease is unknown. Therefore, we undertook a combined analysis using individual data from ADVANCE, EUROPA, and PROGRESS to determine the consistency of the treatment effect of perindopril-based regimen in patients with vascular disease or at high risk of vascular disease.

METHODS AND RESULTS

We studied all-cause mortality and major cardiovascular outcomes during a follow-up of about 4 years in the 29 463 patients randomly assigned a perindopril-based treatment regimen or placebo. The perindopril-based regimens were associated with a significant reduction in all-cause mortality [hazard ratio (HR) 0.89; 95% confidence interval (CI) 0.82-0.96; P = 0.006], cardiovascular mortality (HR 0.85; 95% CI 0.76-0.95; P = 0.004), non-fatal myocardial infarction (HR 0.80; 95% CI 0.71-0.90; P < 0.001), stroke (HR 0.82; 95% CI 0.74-0.92; P = 0.002), and heart failure (HR 0.84; 95% CI 0.72-0.96; P = 0.015). Results were consistent in subgroups with different clinical characteristics, concomitant medication use, and across all strata of baseline blood pressure.

CONCLUSION

This study provides strong evidence for a consistent cardiovascular protection with an ACE-inhibitor treatment regimen (perindopril-indapamide) by improving survival and reducing the risk of major cardiovascular events across a broad spectrum of patients with vascular disease.

Authors+Show Affiliations

Department of Cardiology, Erasmus University Medical Center, Thoraxcenter, 's Gravendijkwal 230, 3015CE, Rotterdam, The Netherlands. j.brugts@erasmusmc.nlNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19346520

Citation

Brugts, Jasper J., et al. "The Consistency of the Treatment Effect of an ACE-inhibitor Based Treatment Regimen in Patients With Vascular Disease or High Risk of Vascular Disease: a Combined Analysis of Individual Data of ADVANCE, EUROPA, and PROGRESS Trials." European Heart Journal, vol. 30, no. 11, 2009, pp. 1385-94.
Brugts JJ, Ninomiya T, Boersma E, et al. The consistency of the treatment effect of an ACE-inhibitor based treatment regimen in patients with vascular disease or high risk of vascular disease: a combined analysis of individual data of ADVANCE, EUROPA, and PROGRESS trials. Eur Heart J. 2009;30(11):1385-94.
Brugts, J. J., Ninomiya, T., Boersma, E., Remme, W. J., Bertrand, M., Ferrari, R., ... Simoons, M. L. (2009). The consistency of the treatment effect of an ACE-inhibitor based treatment regimen in patients with vascular disease or high risk of vascular disease: a combined analysis of individual data of ADVANCE, EUROPA, and PROGRESS trials. European Heart Journal, 30(11), pp. 1385-94. doi:10.1093/eurheartj/ehp103.
Brugts JJ, et al. The Consistency of the Treatment Effect of an ACE-inhibitor Based Treatment Regimen in Patients With Vascular Disease or High Risk of Vascular Disease: a Combined Analysis of Individual Data of ADVANCE, EUROPA, and PROGRESS Trials. Eur Heart J. 2009;30(11):1385-94. PubMed PMID: 19346520.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The consistency of the treatment effect of an ACE-inhibitor based treatment regimen in patients with vascular disease or high risk of vascular disease: a combined analysis of individual data of ADVANCE, EUROPA, and PROGRESS trials. AU - Brugts,Jasper J, AU - Ninomiya,Toshiharu, AU - Boersma,Eric, AU - Remme,Willem J, AU - Bertrand,Michel, AU - Ferrari,Roberto, AU - Fox,Kim, AU - MacMahon,Stephen, AU - Chalmers,John, AU - Simoons,Maarten L, Y1 - 2009/04/04/ PY - 2009/4/7/entrez PY - 2009/4/7/pubmed PY - 2009/7/28/medline SP - 1385 EP - 94 JF - European heart journal JO - Eur. Heart J. VL - 30 IS - 11 N2 - AIMS: Angiotensin-converting enzyme (ACE) inhibitors have been shown to reduce cardiovascular risk in different groups of patients. Whether these effects can be generalized to the broad group of patients with vascular disease is unknown. Therefore, we undertook a combined analysis using individual data from ADVANCE, EUROPA, and PROGRESS to determine the consistency of the treatment effect of perindopril-based regimen in patients with vascular disease or at high risk of vascular disease. METHODS AND RESULTS: We studied all-cause mortality and major cardiovascular outcomes during a follow-up of about 4 years in the 29 463 patients randomly assigned a perindopril-based treatment regimen or placebo. The perindopril-based regimens were associated with a significant reduction in all-cause mortality [hazard ratio (HR) 0.89; 95% confidence interval (CI) 0.82-0.96; P = 0.006], cardiovascular mortality (HR 0.85; 95% CI 0.76-0.95; P = 0.004), non-fatal myocardial infarction (HR 0.80; 95% CI 0.71-0.90; P < 0.001), stroke (HR 0.82; 95% CI 0.74-0.92; P = 0.002), and heart failure (HR 0.84; 95% CI 0.72-0.96; P = 0.015). Results were consistent in subgroups with different clinical characteristics, concomitant medication use, and across all strata of baseline blood pressure. CONCLUSION: This study provides strong evidence for a consistent cardiovascular protection with an ACE-inhibitor treatment regimen (perindopril-indapamide) by improving survival and reducing the risk of major cardiovascular events across a broad spectrum of patients with vascular disease. SN - 1522-9645 UR - https://www.unboundmedicine.com/medline/citation/19346520/The_consistency_of_the_treatment_effect_of_an_ACE_inhibitor_based_treatment_regimen_in_patients_with_vascular_disease_or_high_risk_of_vascular_disease:_a_combined_analysis_of_individual_data_of_ADVANCE_EUROPA_and_PROGRESS_trials_ L2 - https://academic.oup.com/eurheartj/article-lookup/doi/10.1093/eurheartj/ehp103 DB - PRIME DP - Unbound Medicine ER -