%0 Journal Article
%T Effects of Anacetrapib in Patients With Atherosclerotic Vascular Disease - Journal of Vascular Surgery
%A F. Chen
%A J.C. Hopewell
%A K. Wallendszus
%A L. Bowman
%A W. Stevens
%J Journal of Vascular Surgery Home Page
%D 2018
%R https://doi.org/10.1016/j.jvs.2017.11.029
%X 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. 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 even adverse effects on cardiovascular outcomes. In this industrial sponsored 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, a mean non-HDL cholesterol level of 92 mg per deciliter, and a mean HDL cholesterol level of 40 mg per deciliter. The authors have classified it as the phase 3 Randomized Evaluation of the Effects of Anacetrapib through Lipid Modification (REVEAL) trial. Routine follow-up was at 2 months than 6 months until study's end. 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. Secondary outcomes were major atherosclerotic events (a composite of coronary death, myocardial infarction, or presumed ischemic stroke), presumed ischemic stroke (ie, not known to be hemorrhagic), and major vascular events (a composite of major coronary events or presumed ischemic stroke). 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 pre-specified subgroups. At the trial midpoint, the mean level of HDL cholesterol was higher by 43 mg per deciliter 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 (a relative difference of £¿18%).The only secondary outcome not statistically different was the effect of anacetrapib on presumed ischemic stroke
%U https://www.jvascsurg.org/article/S0741-5214(17)32431-X/fulltext