Perindopril has recently been granted a licence extension for the treatment of stable coronary artery disease, to reduce the risk of cardiac events in patients with a history of myocardial infarction (MI) and/or revascularisation. Dr Kristian Bailey and Professor Alistair Hall review the evidence behind this extended role for angiotensin-converting enzyme (ACE) inhibitors and discuss whether this role applies across the whole class.
Cardiovascular disease remains the leading cause of death in the UK, with coronary artery disease (CAD) being the single largest contributory factor. Despite a steady reduction in mortality from acute MI over the past 20 years, the mortality and morbidity of CAD continue to increase, partially as a result of the improvements made in care in the acute setting. Between 1994 and 2003 the overall prevalence of CAD in men in the UK rose from 6.0% to 7.4%, while in women a smaller increase was seen, from 4.1% to 4.5%. Among older age groups, CAD is far more prevalent: 26.4% of men and 18.4% of women over the age of 75 live with CAD.
In 2003, the estimated cost of CAD to the National Health Service (NHS) in the UK was £3,527 million per annum, of which inpatient care and ongoing medication accounted for 95% of the total costs. When effects of CAD mortality and morbidity are taken into account, the estimated cost to the UK economy is £7,910 million per annum. Improvements in care that reduce morbidity and hospitalisation will be beneficial not only to patients themselves, but will also reduce the burden on the NHS and greater economy.