title: Clinical synergy of perindopril and calcium-channel blocker in the prevention of cardiac events and mortality in patients with coronary artery disease. Post hoc analysis of the EUROPA study.
abstract: BACKGROUND
  The purposes of the study were to determine the effects of addition of perindopril to long-term continuous treatment with calcium-channel blocker (CCB) on cardiac outcomes in the stable coronary artery disease (CAD) population of EUROPA and to explore the presence of synergy between perindopril and CCB in secondary prevention.
  
  
  METHODS
  We identified participants receiving CCB at every visit during the 4.2-year follow-up and analyzed the effect of addition of perindopril (n = 1,022 perindopril/CCB vs n = 1,100 placebo/CCB).
  
  
  RESULTS
  Addition of perindopril to CCB significantly reduced total mortality by 46% (P < .01 vs placebo) and primary end point (a composite of cardiovascular mortality, nonfatal myocardial infarction, and resuscitated cardiac arrest) by 35% (P < .05 vs placebo). There were 41%, 54%, and 28% reductions in cardiovascular mortality, hospitalization for heart failure, and myocardial infarction, respectively. Comparison of hazard ratios suggests the presence of a clinical synergy between perindopril and CCB, with a greater effect than addition of individual effects.
  
  
  CONCLUSIONS
  Addition of perindopril to CCB in stable CAD patients had a significant supplementary impact on cardiac outcomes and mortality.
authors.affiliation: Lille Heart Institute, France. mbcardio@club-internet.fr
authors.forename: Michel E
authors.initials: ME
authors.lastname: Bertrand
authors.forename: Roberto
authors.initials: R
authors.lastname: Ferrari
authors.forename: Wilhelm J
authors.initials: WJ
authors.lastname: Remme
authors.forename: Maarten L
authors.initials: ML
authors.lastname: Simoons
authors.forename: Jaab W
authors.initials: JW
authors.lastname: Deckers
authors.forename: K M
authors.initials: KM
authors.lastname: Fox
mesh_terms: D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use*; D002121:Calcium Channel Blockers / Q000494:pharmacology*; D003324:Coronary Artery Disease / Q000188:drug therapy* / Q000401:mortality / Q000517:prevention & control; D004357:Drug Synergism; D004359:Drug Therapy, Combination; D005260:Female; D006760:Hospitalization; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000517:prevention & control; D020913:Perindopril / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use; D016016:Proportional Hazards Models
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D002121:Calcium Channel Blockers; D020913:Perindopril