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 .)

Wie viele Unternehmen sollten an einem Umweltmanagementstandard teilnehmen? Oekonomische Analyse und wirtschaftspolitische Implikationen

Available from TIB Hannover: RR 9274(2000,7) / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekSIGLEDEGerman

The implementation of national and European environmental legislation in Germany: three case studies

This report traces the implementation of the EMAS Regulation in Germany, i.e. it describes what kind of an institutional setting was chosen, in what way it was established and how it is working in practice. Moreover, the outcome of the implementation process is analysed in terms of efficiency and environmental effectiveness. To gain the relevant data and information we conducted expert interviews, reviewed the relevant literature and carried out a questionnaire survey. Chapter 2 provides some background information about EMAS, including the main contents of the EMAS Regulation and the political process that preceded the adoption of the EMAS Regulation and the implementation requirements imposed on the Member States. Chapter 3 describes the implementation of the EMAS Regulation and companies' motives to participate in the scheme. In chapter 4 the outcome of the implementation process is assessed in terms of the attainment of the Regulation's environmental goals and efficiency. To this end the criteria of efficiency (allocative, productive and administrative efficiency) and environmental effectiveness are adapted to the case of EMAS and indicators are developed for their assessment. Finally, data for the indicators are provided for Germany. Chapter 5 develops some hypotheses on how goal attainment and efficiency have been influenced by specific features of the implementation process. (orig.)Available from TIB Hannover: RR 6252(2000,20) / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekSIGLEDEGerman

Die Foerderung des Oeko-Audit-Systems in Deutschland: Ergebnisse einer Befragung der Umwelt- und Wirtschaftsministerien der Laender sowie der Industrie- und Handelskammern und Handwerkskammern

Available from TIB Hannover: RR 6252(1999,12) / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekSIGLEDEGerman

Zukunftschancen im Torgauer Raum: Umweltqualitaet, Ressourcenschutz und wirtschaftliche Entwicklung

Available from TIB Hannover: RR 6252(1999,28) / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekSIGLEDEGerman

Species conservation in the face of political uncertainty

SIGLEAvailable from TIB Hannover: RR 9274(2003,4) / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekDEGerman

Efficiency and applicability of economic concepts dealing with environmental uncertainty A critical analysis

The aim of the paper is to develop evaluation criteria that enable one to analyse the efficiency and applicability of economic concepts dealing with the problem of environmental uncertainty; and to apply these criteria to some of the existing concepts. In order to analyse the applicability of the concepts, environmental uncertainty is divided according to different criteria (for example, the causes for uncertainty). With such a structure, one can show that while the economic concepts are able to deal with some types of environmental uncertainty quite well, they are unable to deal with others adequately. The analysis on efficiency distinguishes between environmental risk and ignorance. Risk describes a situation where scientists are able to attribute probabilities to a variety of outcomes. Ignorance exists when the effects of human activities on the environment are not all known. The evaluation criteria will be applied to analyse the efficiency and applicability of liability, the concept of a risk premium developed by Siebert, the environmental assurance bonding system proposed by Costanza and Perrings as well as the policy recommendation to promote integrated technologies. The analysis shows the following important results: (I) The application possibilities of the four concepts differ significantly. (II) A concpet which concentrates on the reduction of risk may lead to an increase in ignorance. (III) While an economic concept may be efficient in the context of risk, it can be inefficient when ignorance exists. (IV) A trade-off exists between the possibility to precisely state whether an economic concept is efficient and the scope of its applicability. (orig.)SIGLEAvailable from TIB Hannover: RR 9274(1998,2) / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekDEGerman

Towards an efficient spatial allocation of biodiversity-enhancing farming practises

The paper analyses the efficient spatial allocation of farming practices which have a positive impact on biodiversity. For this purpose a spatial allocation model for two different regions is developed which allows guidelines to be derived on how to achieve the highest possible ecological benefit within a given budget provided to support farming practices for conservational purposes. The difference from other economic models dealing with the efficient spatial allocation of environmental goods is that the benefit function of our model is based on ecological theory. In contrast to other conservation biological models, our model includes more realistic economic assumptions. Therefore our results differ from those obtained in monodisciplinary studies. To assess the implementation possibilities of our model's policy recommendations we investigate existing programmes which have been developed under EU Regulation 2078/92 in the German Federal States. The analysis shows that spatial differentiation already exists and that existing types can be used to implement the policies recommended by our results. (orig.)SIGLEAvailable from TIB Hannover: RR 9274(1999,1) / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekDEGerman

EMAS II and regulatory relief in Europe: lessons from national experience

Apart from Germany and Austria, corporate participation in the European Eco-Management and Audit Scheme (EMAS) has remained sluggish and far behind involvement in ISO 14001. Given the lack of response in most EU Member States, the key issue of the current EMAS revision is to increase the incentives for companies to join the Scheme. One of the proposals in this respect is to encourage Member States to consider a lighter regulatory touch for EMAS participants. The aim of this article is to assess the extent to which encouraging regulatory relief may contribute to an increase in the number of EMAS registered companies. For this purpose the regulatory relief already offered to EMAS registered (and ISO 14001 certified) companies in France, Germany, the Netherlands and the United Kingdom are described and analysed. Based on this experience, the central conclusion of the article is that regulatory relief can increase participation in the EMAS and is particularly successful if it is significant and at best integrated into a comprehensive voluntary policy approach aimed at altering the traditional relationship between Government and industry. However, against the background that some countries treat EMAS registration and ISO 14001 certification as equivalent with respect to regulatory relief, even those deregulation measures that fulfil the above conditions may lead to an increase in ISO 14001 certifications rather than EMAS registrations. (orig.)SIGLEAvailable from TIB Hannover: RR 9274(2000,4) / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekDEGerman