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 .)

Persistence and changes in the peripheral Beles basin of Ethiopia

We have investigated the relevance of the notion of "peripheralism" in the Beles basin. In this lowland border area of Ethiopia, important investments require an evaluation of their socio-economic and ecological impacts in the light of Ethiopia's Climate-Resilient Green Economy (CRGE) strategy. We contrasted literature of different periods with field observations. In the middle and lower parts of the basin, the Gumuz people traditionally practised shifting cultivation. Resettlement of highlanders is particularly linked to water and land resources. A large irrigation project was initiated in the 1980s, but vegetables and fruits face post-harvest losses. Large water transfers from Lake Tana since 2010 affect the movement of people, the hydrogeomorphology, and ecology of the river. In several parts of the basin, the settlers' economy now dominates. Many Gumuz became sedentary but maintained their agricultural system, particularly in the south of the lower basin. Land titling allowed allocation of "vacant" areas to transnational or domestic investors. As a result, the semi-natural vegetation is frequently replaced by open cropland, leading to decreased carbon storage and increased soil erosion. This and water abstraction for irrigation jeopardise hydropower production, in contradiction with the CRGE objectives. Despite the recent developments, the contrasts in economic activity make the core-periphery dichotomy to remain actual in the Beles basin. The resettlements and permanent cropping tend to make the upper basin part of the core. However, the installation of a transit road and commercial farms in the lower basin do not allow to consider that a non-peripheral integration has taken place