New strategies needed vs coronary artery disease

One in every two men and in every three woman above the age of 40 is at risk of developing coronary artery disease or CAD. It is projected that by 2020, cardiovascular diseases will account for 37 percent of all deaths. Thus, new strategies to address the problem are urgently needed.

A major concern of most heart specialists worldwide is the increasing prevalence of CAD, caused by a blockade of the heart’s blood vessels that can ultimately lead to the dreaded heart attack.

Despite lifestyle measures, use of certain medicines (aspirin, cholesterol-lowering medicines, heart rate-lowering drugs) and other interventions (bypass surgery and balloon angioplasty), the global burden of CAD is expected to further escalate.

One of the promising medicines for CAD is the class of drugs called angiotensin converting enzyme (ACE) inhibitors, which were initially developed for lowering high blood pressure (BP).

Because of certain special properties of the heart and blood vessels, they have also been used extensively in other conditions like in patients who are suffering from heart failure, heart attack and stroke or brain attack, with excellent results.

So the use of ACE inhibitors may be started even in the so-called prehypertensive phase or in those with normal BPs if there are other compelling indications such as CAD, diabetes with kidney involvement (proteinuria) or heart failure.

The beneficial effects of ACE inhibitors may not be necessarily related to their BP-lowering effects.

Aside from lowering BP, which is an important risk factor in CAD, ACE inhibitors can potentially improve heart and blood vessel wall structure and function, prevent vessel constriction, promote blood vessel dilation, and suppress unnecessary blood clotting – all contributory factors in the development of CAD.

Some studies have initially demonstrated possible beneficial effects of ACE inhibitors in patients with CAD. The results, however, are not always consistent and patient populations were limited mostly to high-risk subjects.

A lot of doctors are looking forward to the results of a large clinical trial which is exploring the potential of an ACE inhibitor drug in patients who have stable CAD without heart failure and are not at very high risk for such a condition – like what the majority of patients really are.

The acronym of this ongoing landmark study is EUROPA, which stands for the EUropean trial on the Reduction Of cardiac events with Perindopril in stable coronary Artery disease.

The EUROPA results will be presented in the European Society of Cardiology (ESC) meeting in Vienna, Austria next month.

The EUROPA study has enrolled 12,236 patients from 24 European countries to determine whether the addition of the ACE inhibitor perindopril to standard therapy decreases cardiovascular deaths, heart attacks and cardiac arrests.

To further elucidate the possible mechanism(s) by which perindopril could reduce morbidity and mortality in CAD patients, several sub-studies have been incorporated into the EUROPA study.

These are designed to provide for a better understanding of the effects of perindopril in preventing coronary artery disease and its complications.