Varespladib and cardiovascular events in patients with an acute coronary syndrome: the VISTA-16 randomized clinical trial

IMPORTANCE: Secretory phospholipase A2(sPLA2) generates bioactive phospholipid products implicated in atherosclerosis. The sPLA2inhibitor varespladib has favorable effects on lipid and inflammatory markers; however, its effect on cardiovascular outcomes is unknown. OBJECTIVE: To determine the effects of sPLA2inhibition with varespladib on cardiovascular outcomes. DESIGN, SETTING, AND PARTICIPANTS: A double-blind, randomized, multicenter trial at 362 academic and community hospitals in Europe, Australia, New Zealand, India, and North America of 5145 patients randomized within 96 hours of presentation of an acute coronary syndrome (ACS) to either varespladib (n = 2572) or placebo (n = 2573) with enrollment between June 1, 2010, and March 7, 2012 (study termination on March 9, 2012). INTERVENTIONS: Participants were randomized to receive varespladib (500 mg) or placebo daily for 16 weeks, in addition to atorvastatin and other established therapies. MAIN OUTCOMES AND MEASURES: The primary efficacy measurewas a composite of cardiovascular mortality, nonfatal myocardial infarction (MI), nonfatal stroke, or unstable angina with evidence of ischemia requiring hospitalization at 16 weeks. Six-month survival status was also evaluated. RESULTS: At a prespecified interim analysis, including 212 primary end point events, the independent data and safety monitoring board recommended termination of the trial for futility and possible harm. The primary end point occurred in 136 patients (6.1%) treated with varespladib compared with 109 patients (5.1%) treated with placebo (hazard ratio [HR], 1.25; 95%CI, 0.97-1.61; log-rank P = .08). Varespladib was associated with a greater risk of MI (78 [3.4%] vs 47 [2.2%]; HR, 1.66; 95%CI, 1.16-2.39; log-rank P = .005). The composite secondary end point of cardiovascular mortality, MI, and stroke was observed in 107 patients (4.6%) in the varespladib group and 79 patients (3.8%) in the placebo group (HR, 1.36; 95% CI, 1.02-1.82; P = .04). CONCLUSIONS AND RELEVANCE: In patients with recent ACS, varespladib did not reduce the risk of recurrent cardiovascular events and significantly increased the risk of MI. The sPLA2inhibition with varespladib may be harmful and is not a useful strategy to reduce adverse cardiovascular outcomes after ACS. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01130246. Copyright 2014 American Medical Association. All rights reserved

93: UK); J. Matousek (1985-93; Czechoslovakia); H. J. Matzke (1987-93; Germany); R. W. Ohse (1985-87; Germany); G.-M. Rosenblatt (1985-91; USA); T. Saito (1989-93; Japan)

Republication or reproduction of this report or its storage and/or dissemination by electronic means is permitted without the need for formal IUPAC permission on condition that an acknowledgement, with full reference to the source along with use of the copyright symbol 0, the name IUPAC and the year of publication are prominently visible. Publication of a translation into another language is subject to the additional condition of prior approval from the relevant IUPAC National Adhering Organization. Quantitative analysis of a PbO-Si02 glass by electron microprobe (Technical Report) Synopsis: A standard glass sample denoted by the National Institute of Standards and Technology as K-456 was analyzed by an international collaborative team. The results of quantitative determinations of the two oxide glass components, PbO and SOz, are compared and the deviations from the standard values are calculated. Methods of preparation, conditions of quantitative determination and procedures used for the evaluation of the results are also summarized. INTRODUCTION Quantitative determination of the composition of lead glasses by means of electron probe microanalysis (EPMA) appears to be relatively difficult especially if they contain a large amount of Pb. In addition to the uncertainities caused by specimen preparation and by the choice of parameters of the measurements, the selection of standards and the correction methods used for the evaluation of the results have considerable influence. A glass sample consisting of PbO and SiO, was chosen to compare and verify procedures used in a number of laboratories dealing with analysis of glasses by means of electron microprobe. This study follows the paper describing results of electron probe microanalysis of a multicomponent glass obtained by an international collaborative team and phlished previously [I]