Key result
Perindopril-based therapy cuts major CV events by ~13% in statin users and more in non-statin users.
Why the study?
The effects of a perindopril-based regimen on cardiovascular outcomes in patients with vascular disease in relation to background statin therapy were unclear.
Does a perindopril-based regimen reduce the composite of cardiovascular mortality, nonfatal MI, and stroke in patients with vascular disease, independent of background statin therapy?
Meta-Analysis (n=29,463)
Double-blind
Randomized
Yes
Does a perindopril-based regimen reduce the composite of cardiovascular mortality, nonfatal MI, and stroke in patients with vascular disease, independent of background statin therapy?
Effect estimate: HR 0.87 (95% CI 0.77-0.98)
Absolute Event Rate: 8.6% vs 10%
A perindopril-based regimen significantly reduces cardiovascular events in patients with vascular disease, providing additive benefits that are independent of background statin therapy.
Perindopril-based regimens reduce CV events in vascular disease regardless of statin use; confirms additive benefit from three major RCTs.
PURPOSE: To study the effects of a perindopril-based regimen on cardiovascular (CV) outcomes in patients with vascular disease in relation to background statin therapy. METHODS: A pooled analysis of the randomized ADVANCE, EUROPA, and PROGRESS trials was performed to evaluate CV outcomes in 29,463 patients with vascular disease treated with perindopril-based regimens versus placebo. The primary endpoint was a composite of CV mortality, nonfatal myocardial infarction, and stroke. Multivariable Cox regression analyses were performed to assess the effects of a perindopril-based regimen versus placebo in relation to statin use. RESULTS: At randomization, 39.5% of the overall combined study population used statins. After a mean follow-up of 4.0 years (SD 1.0), the cumulative event-free survival was highest in the statin/perindopril group and lowest in the no statin/placebo group (91.2% vs. 85.6%, respectively, log-rank p < 0.001). In statin users (adjusted hazard ratio [aHR] 0.87, 95% confidence interval [CI] 0.77-0.98) and non-statin users (aHR 0.80, 95% CI 0.74-0.87), a perindopril-based regimen was associated with a significantly lower risk of the primary endpoint when compared to placebo. The additional treatment effect appeared numerically greater in non-statin users, but the observed difference was statistically nonsignificant. CONCLUSION: Our data suggest that the treatment benefits of a perindopril-based regimen in patients with vascular disease are independent of statin use.
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Radhoe et al. (2022) conducted a meta-analysis in Vascular disease (n=29,463). Perindopril-based regimen vs. Placebo was evaluated on Composite of cardiovascular mortality, nonfatal myocardial infarction, and stroke (statin users) (HR 0.87, 95% CI 0.77-0.98). A perindopril-based regimen reduced the risk of cardiovascular mortality, nonfatal myocardial infarction, and stroke by 13% in statin users (HR 0.87) and 20% in non-statin users (HR 0.80).
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