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. 2024 Feb;38(1):131-139.
doi: 10.1007/s10557-022-07384-2. Epub 2022 Oct 4.

The Effects of a Perindopril-Based Regimen in Relation to Statin Use on the Outcomes of Patients with Vascular Disease: a Combined Analysis of the ADVANCE, EUROPA, and PROGRESS Trials

S P Radhoe  1 , E Boersma  2 , M Bertrand  3 , W Remme  4 , R Ferrari  5 , K Fox  6 , S MacMahon  7 , J Chalmers  7 , M L Simoons  2 , J J Brugts  2
Affiliations

The Effects of a Perindopril-Based Regimen in Relation to Statin Use on the Outcomes of Patients with Vascular Disease: a Combined Analysis of the ADVANCE, EUROPA, and PROGRESS Trials

S P Radhoe et al. Cardiovasc Drugs Ther. 2024 Feb.

Abstract

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.

Keywords: ACE inhibitor; Hypertension; Perindopril; Prevention; Statin; Vascular disease.

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Conflict of interest statement

J.J.B., J.C., S.M., K.F., R.F., W.R., M.L.S., and E.B. have received independent research grants from Servier. W.R. serves as Senior Editor for Cardiovascular Drugs and Therapy.

Figures

Fig. 1
Fig. 1
Cumulative survival free from the primary endpoint for patients randomized to a perindopril-based regimen or placebo according to statin use
Fig. 2
Fig. 2
Treatment effects of a perindopril-based regimen versus placebo in A the statin use stratum and B the no-statin use stratum
See this image and copyright information in PMC

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