ACE inhibition with perindopril and biomarkers of atherosclerosis and thrombosis: Results from the PERTINENT study

The PERTINENT study measured biomarkers of atherosclerosis and thrombosis ill a Stable Coronary artery disease population from EUROPA receiving ACE inhibition with perindopril 8 mg/day of placebo. Biomarkers of inflammation, C-reactive protein (CRP), fibrinogen, and tumor necrosis factor-alpha (TNF-alpha), and a biomarker of thrombosis, D-dimer, were measured at baseline and I year. CRP was recorded in 1157 patients; fibrinogen, TNF-alpha, and D-dimer in 291 patients. There was no significant effect of treatment oil CRP or fibrinogen. In contrast, there were significant reductions in TNF-alpha (27.60-25.20 pg/mL; P < 0.05) and D-dimer (0.24-0.18 mu g/mL; P < 0.05) with perindopril over I year. Survival analysis of the prognostic significance of baseline CRP failed to detect a significant role for the prediction of cardiovascular events over 4 years (lower versus higher tertile: 1.54; 95% confidence interval 0.88-2.68: P=0.16). In conclusion, ill the PERTINENT trial, we observed significant effects of ACE inhibition oil biomarkers of the atherothrombotic complications (D-dimer) and the proinflammatory cytokine TNF-alpha, but not on biomarkers of inflammation associated with atherosclerosis (CRP and fibrinogen). (C) 2008 Published by Elsevier Ireland Ltd