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EUROPA in brief

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EUROPA in brief
According to the World Health Report 2002, of an estimated 56 million deaths worldwide in 2001, more than 29% were due to cardiovascular disease. Coronary artery disease (a condition where the blood vessels supplying the heart become narrowed) – the most common manifestation of cardiovascular disease – is attributed with over 12% of deaths, making it one of the principal causes of death worldwide.1 People with coronary artery disease may experience chest pain, shortness of breath and even heart attacks, although the condition can also be present without any noticeable symptoms. Despite changes in lifestyle and the use of modern medical and surgical techniques, the burden of this disease is expected to increase over the coming years. New strategies to tackle this worldwide threat are therefore urgently needed.

Angiotensin converting enzyme (ACE) inhibitors, such as perindopril, have a well-established role in the treatment of hypertension (high blood pressure), heart failure (a condition in which the heart has problems pumping blood) and after a myocardial infarction (heart attack). Importantly, evidence also suggests that they have huge potential in the treatment of coronary artery disease. However, until the EUROPA study, no long-term trial had ever investigated the effect of ACE inhibitors in the overall unselected population of patients who only have evidence of coronary artery disease.

The EUROPA study – the eagerly awaited results of which were presented at the European Society of Cardiology in Vienna, August, 31, 2003 – investigated the effects of the ACE inhibitor perindopril, added to optimal therapy, on cardiac events in patients with stable coronary artery disease (e.g., patients with a previous heart attack or with narrowing of a major artery), but without heart failure. Perindopril was a particularly appropriate choice of ACE inhibitor due to its proven efficacy and safety profile, in the treatment of hypertension and heart failure, which have been demonstrated through an extensive clinical trials programme with more than 500 ongoing and completed trials involving more than 100,000 patients.

The EUROPA study began recruiting patients from 1997 until June 2000, from 24 European countries and is the largest ever trial to address the management of patients with coronary artery disease. 12,218 patients aged at least 18 years (mean age of 60 years) were randomised from 424 centres and then randomly divided into two treatment groups. One group received four years of treatment with 8 mg once daily of perindopril in addition to their existing medication(s) and the other group received placebo over the same period.

The EUROPA study was designed primarily to determine whether adding perindopril to optimal therapy decreased the rate of:
Cardiovascular death
Acute myocardial infarction (heart attack)
Cardiac arrest (a sudden cessation of heartbeat resulting in the loss of circulation) with successful resuscitation (recovery).

In addition, selected secondary end points of the study were: cardiovascular mortality, myocardial infarction, heart failure, total mortality, revascularisation (PTCA, CABG), stroke and unstable angina.

The EUROPA study also includes five sub-studies, evaluating the effect of perindopril on diabetes, endothelium dysfunction, atherosclerosis, blood products associated with atherosclerosis. These sub-studies have been designed to provide a better understanding of the exact mechanism(s) via which perindopril exerts its effect in patients with coronary artery disease.


1. The World Health Report 2002: Reducing risks, promoting healthy life. World Health Organization.

2. Gomma AH, Fox KM. On behalf of the EUROPA investigators. The EUROPA trial: design, baseline demography and status of the substudies. Cardiovasc Drugs Ther. 2001;15:169–179.

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