Effects of Anacetrapib in Patients with Atherosclerotic Vascular Disease

BACKGROUND: Patients with atherosclerotic vascular disease remain at high risk for cardiovascular events despite effective statin-based treatment of low-density lipoprotein (LDL) cholesterol levels. The inhibition of cholesteryl ester transfer protein (CETP) by anacetrapib reduces LDL cholesterol levels and increases high-density lipoprotein (HDL) cholesterol levels. However, trials of other CETP inhibitors have shown neutral or adverse effects on cardiovascular outcomes. METHODS: We conducted a randomized, double-blind, placebo-controlled trial involving 30,449 adults with atherosclerotic vascular disease who were receiving intensive atorvastatin therapy and who had a mean LDL cholesterol level of 61 mg per deciliter (1.58 mmol per liter), a mean non-HDL cholesterol level of 92 mg per deciliter (2.38 mmol per liter), and a mean HDL cholesterol level of 40 mg per deciliter (1.03 mmol per liter). The patients were assigned to receive either 100 mg of anacetrapib once daily (15,225 patients) or matching placebo (15,224 patients). The primary outcome was the first major coronary event, a composite of coronary death, myocardial infarction, or coronary revascularization. RESULTS: During the median follow-up period of 4.1 years, the primary outcome occurred in significantly fewer patients in the anacetrapib group than in the placebo group (1640 of 15,225 patients [10.8%] vs. 1803 of 15,224 patients [11.8%]; rate ratio, 0.91; 95% confidence interval, 0.85 to 0.97; P=0.004). The relative difference in risk was similar across multiple prespecified subgroups. At the trial midpoint, the mean level of HDL cholesterol was higher by 43 mg per deciliter (1.12 mmol per liter) in the anacetrapib group than in the placebo group (a relative difference of 104%), and the mean level of non-HDL cholesterol was lower by 17 mg per deciliter (0.44 mmol per liter), a relative difference of -18%. There were no significant between-group differences in the risk of death, cancer, or other serious adverse events. CONCLUSIONS: Among patients with atherosclerotic vascular disease who were receiving intensive statin therapy, the use of anacetrapib resulted in a lower incidence of major coronary events than the use of placebo. (Funded by Merck and others; Current Controlled Trials number, ISRCTN48678192 ; ClinicalTrials.gov number, NCT01252953 ; and EudraCT number, 2010-023467-18 .)

U.S.-Budgetdefizit, Dollarkurs und internationale Verschuldungssituation. T. 1 Theoretische Wirtschaftsanalyse

Bibliothek Weltwirtschaft Kiel C 136,415 / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekSIGLEDEGerman

Nachfrageorientierte Beschaeftigungspolitik, oeffentliche Kreditaufnahme und Verschuldungsdynamik

Bibliothek Weltwirtschaft Kiel C128,016 / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekSIGLEDEGerman

Einkommens-, Zins- und Zahlungsbilanzeffekte einer staatlichen Inlands- und Auslandsneuverschuldung bei festen Wechselkursen Eine Simulationsstudie mit einem Zwei-Laender-Modell

Bibliothek Weltwirtschaft Kiel C128,017 / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekSIGLEDEGerman

Risiken der internen und externen Neuverschuldung des Staates Gedanken zu einem aktuellen Problem der Finanzpolitik in der Bundesrepublik Deutschland

SIGLEBibliothek Weltwirtschaft Kiel C128,015 / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekDEGerman

Wirtschaftsentwicklung und Wirtschaftspolitik der Bundesrepublik Deutschland im internationalen Vergleich

Bibliothek Weltwirtschaft Kiel C 150375 / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekSIGLEDEGerman

U.S.-Budgetdefizit, Dollarkurs und internationale Verschuldungssituation. T. 2 Empirische Untersuchungen und Simulationen mit einem oekonometrischen Drei-Laender-Modell

Bibliothek Weltwirtschaft Kiel C 136,415 / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekSIGLEDEGerman

Grundzuege einer Theorie der staatlichen Auslandsverschuldung. T. 3 Staatliche Auslands- versus staatliche Inlandsneuverschuldung. Eine kurz- und langfristige modelltheoretische Analyse fuer flexible Wechselkurse

Bibliothek Weltwirtschaft Kiel C128,013 / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekSIGLEDEGerman

Sectoral transmission and aggregate effects of imported inflation An econometrical input-output-model for the Federal Republic of Germany

SIGLEBibliothek Weltwirtschaft Kiel C 150550 / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekDEGerman

Internationale Wirtschaftsverflechtungen und staatliche Neuverschuldung

SIGLEBibliothek Weltwirtschaft Kiel C127,999 / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekDEGerman