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ACE Inhibitor Therapy Cardioprotective in Diabetics With Coronary Disease

Aug 16, 2005

In diabetic patients with coronary disease, treatment with perindopril, an angiotensin converting enzyme inhibitor (ACEI), helps protect against major cardiovascular events.

These are the findings of the Perindopril Substudy in Coronary Artery Disease and Diabetes (PERSUADE) study, the diabetic substudy of EUROPA, a large placebo-controlled study, which assessed the effect of perindopril 8 mg once daily on outcome in a general stable CAD population.

In the PERSUADE substudy, a total of 1502 diabetic patients with known CAD and without heart failure were randomly assigned to perindopril or placebo, Dr. Caroline A. Daly from Royal Brompton Hospital in London and colleagues explain in the European Heart Journal for July.

After a median follow up of 4.3 years, 12.6% of perindopril-treated diabetics experienced cardiovascular death, non-fatal MI, or resuscitated cardiac arrest — the primary end point — compared with 15.5% of placebo-treated diabetics, a relative risk reduction of 19%.

"Although not statistically significant, the 19% relative risk reduction in the primary endpoint closely matches the 20% relative risk reduction in the main EUROPA population," the authors note. They also point out that PERSUADE was not powered to detect significant differences between perindopril and placebo.

"Because the cardiovascular event rate in diabetics is higher than (in) the general population with coronary disease, any relative reduction in events will translate into a greater absolute reduction," Dr. Daly and colleagues write.

They also point out that the trend towards a reduction in cardiovascular events in diabetics with coronary disease treated with perindopril were achieved "despite excellent use of other secondary preventative therapy" including antiplatelets, beta-blockers and statins.

In a related editorial, a group of Canadian clinicians writes that, "with the addition of PERSUADE to the well established MICRO-HOPE data, clinicians must recognize the important role of ACE inhibitors for vascular protection in high-risk diabetic subjects."

"We believe the time has come to move away from a ‘glucocentric’ view of diabetes and PERSUADE physicians to protect the diabetic vasculature as the top priority," Dr. Subodh Verma from the University of Toronto and colleagues conclude.
Euro Heart J 2005;26:1347-1349,1369-1378.


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