This significant effect was derived by the use of fibrates ( RR 0.80 , 95 % CI 0.73–0.87 , P < 0.001 , I2 = 22 % ) and meta-regression analysis showed that this benefit was consistent with an absolute reduction in low-density lipoprotein cholesterol .
Meta-regression analyses failed to demonstrate a significant association of pharmacologically increased high-density lipoprotein cholesterol with key endpoints .
Conclusion The use of high-density lipoprotein cholesterol modifying treatments had no significant effect on cardiovascular mortality , stroke or all-cause mortality .
The beneficial effect on myocardial infa rct ion was lost when drugs were used with statin therapy
Background The effects of increasing high-density lipoprotein cholesterol on cardiovascular outcomes remain uncertain .
Design We conducted a meta- analysis to investigate the effects of high-density lipoprotein cholesterol modifiers ( niacin , fibrates and cholesteryl ester transfer protein inhibitors ) on cardiovascular outcomes .
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 r and omized , 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 infa rct ion , 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 result ed in a lower incidence of major coronary events than the use of placebo . ( Funded by Merck and others ; Current Controlled Trials number , IS RCT N48678192 ; Clinical Trials.gov number , NCT01252953 ; and EudraCT number , 2010‐023467‐18 .
This significant effect was derived by the use of fibrates ( RR 0.80 , 95 % CI 0.73–0.87 , P < 0.001 , I2 = 22 % ) and meta-regression analysis showed that this benefit was consistent with an absolute reduction in low-density lipoprotein cholesterol .
Meta-regression analyses failed to demonstrate a significant association of pharmacologically increased high-density lipoprotein cholesterol with key endpoints .
Conclusion The use of high-density lipoprotein cholesterol modifying treatments had no significant effect on cardiovascular mortality , stroke or all-cause mortality .
The beneficial effect on myocardial infa rct ion was lost when drugs were used with statin therapy
Background The effects of increasing high-density lipoprotein cholesterol on cardiovascular outcomes remain uncertain .
Design We conducted a meta- analysis to investigate the effects of high-density lipoprotein cholesterol modifiers ( niacin , fibrates and cholesteryl ester transfer protein inhibitors ) on cardiovascular outcomes .