Wider use of heart drugs is advised
ACE inhibitors should be prescribed in more than 60 per cent of patients with stable coronary artery disease, a new study concludes.
The research an analysis of 12,218 patients on the Europe-wide EUROPA trial suggests the drugs would be cost-effective in many more patients than are currently receiving them.
The researchers have developed a risk-scoring system to accurately identify the patients in whom ACE inhibitors would be cost-effective.
Study leader Dr Jaap Deckers, associate professor of cardiology at Erasmus University Medical Centre in Rotterdam, the Netherlands, said: 'Risk stratification in these patients proved to be very meaningful, as a surprisingly large gradient appeared to be present.
'Treating those with a yearly risk of 2 per cent or above would be reasonable and is cost-effective.'
The researchers, whose study is published online by the European Heart Journal, said their results challenged assumptions that patients with stable coronary artery disease had relatively low risk of cardiovascular events.
A third of patients had a 10-year risk of 30 per cent or more and 28 per cent a risk of between 20 and 30 per cent.
Researchers calculated that ACE inhibitors would be cost-effective in all these patients.
The study results are in-corporated into the new risk score, which estimates risk using a range of clinical factors including age, blood pressure, cholesterol, previous MI and stroke, and symptomatic coronary artery disease (see box, right).
Previous stroke or PVD 3
Current smoker 2
Symptomatic CAD 2
Previous MI 2
Family history of CAD 1
Previous revascularisation 1
Sliding scale based on age, blood pressure, clearance and cholesterol 0-7
ACE inhibitors cost-effective from scores >7