C arboxylgroup

Pyrolgroup

C H 2 C H 3

C O O H

C O O C H2 5

NC OC HN HC HC H 2

Chemical Structure of Chemical Structure of RamiprilRamipril

Chemical Structure of PerindoprilChemical Structure of Perindopril

Clinical characteristics Clinical characteristics HOPE vs. EUROPAHOPE vs. EUROPA

2969Lipid – lowering therapy (%)

3962Beta – blockers (%)

7692Antiplatelet treatment (%)

113.3Previous stroke (%)

43.555Previous revascularization (%)

5365Previous MI (%)

38.412Diabetics (%)

4727Hypertensive (%)

CAD Non CAD

CADPopulation

Ramipril 10 mg/day

Perindopril 8 mg/day

ACEI dosage

73.385Male (%)

6660Age (years)

929712218N

HOPEEUROPA

22%20%Relative Risk Redn. in Pri. End Point

HOPE vs. EUROPAHOPE vs. EUROPAStudy populationStudy population HOPEHOPE EUROPAEUROPAAge (yrs)Age (yrs) 6666 6060Female gender (%)Female gender (%) 2727 1515Known CAD (%)Known CAD (%) 8080 100100Previous MI (%)Previous MI (%) 5353 6565PVD (%)PVD (%) 4343 77Stroke/TIA (%)Stroke/TIA (%) 1111 33Diabetes (%)Diabetes (%) 3838 1212Hypertension (%)Hypertension (%) 4747 2727Hypercholesterolemia(%)Hypercholesterolemia(%) 6666 6363

BaselineBaseline HOPEHOPE EUROPAEUROPA

Antiplatelet Antiplatelet drugs*drugs*

76 %76 % 92 %92 %

-blockers-blockers 39 %39 % 62 %62 %

Lipid lowering Lipid lowering drugsdrugs

29 %29 % 58 %58 %

* Mostly aspirin* Mostly aspirinMore extensive treatment in EUROPA than in HOPEMore extensive treatment in EUROPA than in HOPE

HOPE vs. EUROPAHOPE vs. EUROPA

HOPEHOPE EUROPAEUROPA

Total mortalityTotal mortality 12.2%12.2% 7.4 %7.4 %

CV mortalityCV mortality 8.1%8.1% 4.4%4.4%

Q wave MIQ wave MI 3.2%3.2% 2.1%2.1%

Major annual event rates : 50 to 80 % Major annual event rates : 50 to 80 % higherhigher in HOPE in HOPE

Placebo outcomes standardised for 4.5 yrs FUPlacebo outcomes standardised for 4.5 yrs FU

HOPE vs. HOPE vs. EUROPAEUROPA

ConclusionConclusion EUROPA is the only ACE inhibitor trial done in true EUROPA is the only ACE inhibitor trial done in true

CAD patients across all age groups, even in the CAD patients across all age groups, even in the young patients, below 55 years.young patients, below 55 years.

In EUROPA there were all kinds of CAD patients, at In EUROPA there were all kinds of CAD patients, at various levels of risk.various levels of risk.

All patients in EUROPA had documented CAD.All patients in EUROPA had documented CAD. In EUROPA all patients were optimally controlled In EUROPA all patients were optimally controlled

with other modern preventive therapies like Beta with other modern preventive therapies like Beta blockers, Aspirin and Statins. blockers, Aspirin and Statins.

And of course, this is the largest study ever And of course, this is the largest study ever performed in patients with CAD.performed in patients with CAD.

In fact,the patients in EUROPA are similar to the In fact,the patients in EUROPA are similar to the patients we see in our day-to-day practice unlike in patients we see in our day-to-day practice unlike in HOPE with Ramipril.HOPE with Ramipril.

ConclusionConclusion•• No doubt ramipril is a good drug,No doubt ramipril is a good drug, but but COVERSYL COVERSYL scores abovescores above ramipril in certain areas:ramipril in certain areas: Better 24 hours B.P. controlBetter 24 hours B.P. control Better safety profile – less coughBetter safety profile – less cough Proven data in all types of CAD Proven data in all types of CAD

patientspatients Proven data on secondary stroke Proven data on secondary stroke

prevention (PROGRESS)prevention (PROGRESS) Proven data on diabetic Proven data on diabetic

endpoints(ADVANCE)endpoints(ADVANCE)