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
Key result
A perindopril-based regimen significantly reduced all-cause mortality (HR 0.89; 95% CI 0.82-0.96; P=0.006) and major cardiovascular events in patients with or at high risk of vascular disease.
Why the study?
Does a perindopril-based treatment regimen reduce mortality and major cardiovascular events in patients with vascular disease or at high risk of vascular disease?
Population
29,463 patients with vascular disease or at high risk of vascular disease
Comparison
Perindopril-based treatment regimen vs Placebo
Design
Meta-analysis, Randomly assigned
Follow-up
about 4 years
Authors
Discussion
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Member takes
Implication
Supports perindopril-based regimens to reduce mortality in high-risk vascular patients; confirms benefit across broad populations in meta-analysis.
Key Points
- Determine whether the cardiovascular protective effects of a perindopril-based treatment regimen are consistent across a broad spectrum of patients with or at high risk of vascular disease.
- Conducted a combined individual participant data analysis of 29,463 patients from three randomized trials: ADVANCE, EUROPA, and PROGRESS.
- Assigned patients randomly to a perindopril-based treatment regimen or placebo, with an average follow-up duration of approximately 4 years.
- Evaluated primary outcomes including all-cause mortality, cardiovascular mortality, non-fatal myocardial infarction, stroke, and heart failure.
- Perindopril-based therapy significantly reduced all-cause mortality (HR 0.89; 95% CI 0.82–0.96; P = 0.006) and cardiovascular mortality (HR 0.85; 95% CI 0.76–0.95; P = 0.004).
- Significant reductions occurred for 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).
- Treatment benefits remained consistent across clinical subgroups, concomitant medication categories, and across all baseline blood pressure strata.
Study Design
Type
Meta-Analysis (n=29,463)
Multicenter
Yes
Structured PICO
Does a perindopril-based treatment regimen reduce mortality and major cardiovascular events in patients with vascular disease or at high risk of vascular disease?
P
Population
29,463 patients with vascular disease or at high risk of vascular disease
I
Intervention
Perindopril-based treatment regimen (perindopril-indapamide)
C
Comparator
Placebo
O
Outcome
All-cause mortality and major cardiovascular outcomeshard clinical
Main Result
Effect estimate: HR 0.89 (95% CI 0.82-0.96)
p-value: p=0.006
A perindopril-based treatment regimen consistently reduces all-cause mortality and major cardiovascular events across a broad spectrum of patients with or at high risk for vascular disease.
Cite This Study
Brugts et al. (2009) conducted a meta-analysis in vascular disease or high risk of vascular disease (n=29,463). perindopril-based treatment regimen vs. placebo was evaluated on all-cause mortality (HR 0.89, 95% CI 0.82-0.96, p=0.006). A perindopril-based regimen significantly reduced all-cause mortality (HR 0.89; 95% CI 0.82-0.96; P=0.006) and major cardiovascular events in patients with or at high risk of vascular disease.