Heart patients who feel quite well and have normal blood pressure are less likely to have a heart attack or die from a heart attack or stroke if they take a type of blood pressure drug in addition to their normal medication, new research has shown. The finding, which could drastically increase the number of people taking such medicine, emerges from the largest experiment ever to test the power of so-called ACE inhibitor drugs.
Ace Inihibitors are already recommended for coronary heart patients over 55, those with heart failure and others at high risk of dying from complications, such as stroke survivors and people with diabetes or high blood pressure.
“The biggest part of the jigsaw are the people that are left,” said Dr. Kim Fox of the Royal Brompton Hospital in London, who directed the study. “There is a much bigger pool of patients out there who are dying of coronary disease even though they feel quite well.”
Fox described the study results as a milestone in the treatment of heart disease, proving for the first time that an ACE inhibitor can have life-saving benefits even in younger coronary patients and those considered to be at low risk of complications.
Preventing more heart attack
The study, which was presented Sunday at the annual meeting of the European Society of Cardiology in Vienna, found that those who added one type of ACE inhibitor, perindopril, to their daily medication had a 20 percent lower risk of dying from a heart attack or stroke or of having a survivable heart attack than those who did not take the extra pill. Their risk of being admitted to hospital with heart failure was 39 percent lower. All heart attacks were down 24 percent.
"We are asking the government authorities to consider giving perindopril to all people with coronary disease,” regardless of their age or condition, Fox said.
The study was financed by Servier, the French pharmaceutical company that makes the pill used in the study.
Perindopril is known as Aceon in the United States and as Coversyl in Europe and elsewhere. Other ACE inhibitors include ramipril, quinapril, lisinopril, and captopril.
In the study, perindopril prevented one person from dying of a heart attack or stroke or from having a survivable heart attack out of every 50 people given the drug for four years.
That means that over four years, the treatment could prevent 330,000 such attacks across Europe, and another 250,000 in the United States, Fox said.
All heart patients eligible?
Experts said the results, together with studies of other ACE inhibitors, indicate that such drugs should now be considered for all patients with coronary disease. They suspect that any ACE inhibitor, not just perindopril, will work in these patients.
“This will broaden the indications (for using the drugs) considerably,” said Dr. Eugene Braunwald, professor of medicine at Harvard Medical School. “In the United States, the cost and the kind of deal that you make with the insurance company is much more important than which ACE inhibitor to use.”
Coronary artery disease is the most common form of heart disease, the leading killer in the Western world.
About 13 million Americans have it, 20 million Europeans, experts estimate. The American Heart Association predicts that 1 million Americans will have a coronary attack this year.
Over the past few decades, prevention efforts and new drugs have substantially improved the outlook of these patients. However, the risk of complications is still high and despite treatment with cholesterol-lowering drugs, aspirin, and beta blockers, the disease usually progresses.
“Any improvement that we can make to this disease will have a huge impact in the delivery of healthcare throughout the Western world,” Fox said.
First used to treat hypertension, scientists now believe angiotensin converting enzyme, or ACE, inhibitors, do more than just lower blood pressure. They may have an effect on the arteries themselves.
The study was conducted on 12,218 people with coronary heart disease from 24 countries who were aged 18 or older and had different severities of disease but did not have heart failure or seriously high blood pressure. They were all on standard medication for their condition — mostly aspirin, a cholesterol buster and a beta blocker. In addition, half got perindopril and half got a dummy pill.
During the four years of the study, 10 percent of those on the fake pill died from heart disease, had a heart attack or had to be resuscitated after cardiac arrest. That compared with 8 percent of those taking the ACE inhibitor. That translated into a 20 percent lower risk of problems for the group taking the pill.