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 .)

Public Spaces and Alternative Media Practices in Europe: The Case of the EuroMayDayParade against Precarity

This chapter deals with the role of emerging transnational public spaces for communication and collective identification in contemporary social movement groups in different European countries and at the transnational level of European Union (EU) politics. Related to globalization, European integration, and the increasing use of internet communication technologies (ICTs) by activists, national public spaces in the twenty-seven member states of the EU pass through a process of transformation that might deeply redefine democratic and participation practices. In this chapter, we discuss the emergence of a loose critical Europeanist collective identity1 revolving around the political concept of \u201cprecarity\u201d and linked to the organization of a transnational protest campaign, the EuroMayDay Parade (EMP), against precarious and insecure work.2 In particular, we focus on how collective identification processes were discursively constructed in the protest campaign through the elaboration of alternative media practices toward the transnational European level. Activists constructed \u201cparallel discursive arenas\u201d (Fraser 1992: 123) in which the feeling of being European precarious workers found a potential space of expression and consolidation. Though these arenas were and still are fragile and temporary, they show how important alternative media practices and the resulting independent spaces of communication are for the emergence of critical Europeanist collective identities. In doing this, we offer important insights related to the existence of the so-called public deficit of the European Union, including the lack of truly European mainstream media. It also suggests that scholars interested in the emergence of European public spheres might look not only at the mainstream media, but also at more grassroots forms of mediation and communication. This chapter is structured as follows. The first section presents the broad theoretical framework that supported the analysis. The second section introduces the methods employed to construct and analyze data, and the third section presents the case study. The fourth section investigates how collective identification processes took place in the EMP, focusing on alternative media practices. The fifth section discusses the challenges that the construction of critical Europeanist collective identities implied for activists. The conclusion sums up the most interesting points that the analysis raised