The European Trial on Reduction of Cardiac Events with Perindopril in Stable Coronary Artery Disease (EUROPA) investigated the effect of angiotensin-converting enzyme inhibition on the prevention of cardiac events in patients with stable coronary artery disease (CAD) without apparent heart failure. Perindopril 8 mg/day significantly reduced a composite outcome of cardiovascular death, nonfatal myocardial infarction or resuscitated cardiac arrest by 20% compared with placebo, in addition to standard preventive therapies. This review describes the substudies and subpopulation analyses carried out within the EUROPA population, concluding that the benefits of perindopril extend to all stable CAD patients, even revascularized patients or those with preserved left ventricular function. Data on the pathophysiological mechanisms underlying CAD indicate direct vascular protection with perindopril. This helps explain why perindopril is beneficial in preventing cardiac events in stable CAD patients.

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Expert Review of Cardiovascular Therapy
Erasmus MC: University Medical Center Rotterdam

Ferrari, R., Bertrand, M., Remme, W., Simoons, M., Deckers, J., & Fox, K. (2007). Insight into ACE inhibition in the prevention of cardiac events in stable coronary artery disease: The EUROPA trial. Expert Review of Cardiovascular Therapy (Vol. 5, pp. 1037–1046). doi:10.1586/14779072.5.6.1037