However, the mean systolic blood pressure remained approximately 0. There were no significant between-group differences in diastolic blood pressure; pulse rate; levels lei plasma aldosterone, potassium, 9795 bicarbonate; or the number of prescribed antihypertensive medications. Hyperten-sion was reported 9795 frequently as an lei or serious adverse event in the dalcetrapib group than in the placebo group see the Supplementary Appendix.
Diarrhea occurred more frequently in the dalcetrapib group than in the placebo group in patients vs. More patients in the dalcetrapib group than in the placebo group had insomnia patients vs. There were no significant differences between the groups in new diagnoses of or deaths from cancers or infections see the Supplementary Appendix.
Dalcetrapib had no significant effect on measures of hepatic or renal function or on creatine kinase levels.
Despite the finding that dalcetrapib, as compared with placebo, produced a substantial increase in HDL cholesterol levels, it had no lei effect on major cardiovascular outcomes, including the rate of death from coronary heart disease and the rates of myocardial 9795, ischemic stroke, unstable angina, cardiac arrest with resuscitation, and unanticipated coronary revascularization.
9795 net benefit or harm was evident in any major subgroup of the study cohort. Because dalcetrapib had minimal effects on levels of LDL cholesterol and apolipoprotein B and a small effect on triglyceride levels, the dal-OUTCOMES trial may provide the purest test to date of the value of therapeutic intervention to raise HDL cholesterol levels in patients with coronary heart disease.
There are several possible explanations for the lack of benefit of dalcetrapib treatment. First, and in contrast to findings in epidemiologic analyses and post hoc analyses of data from some placebo-controlled trials of statins, no association was shown between HDL cholesterol levels and cardiovascular risk among the patients evaluated in this trial, even those in the placebo group.
The absence of such an association may indicate that HDL lei levels are no longer a determinant of risk when patients are treated with 9795 type of evidence-based therapies that were used in the trial, including statins, dual antiplatelet therapy, beta-blockers, ACE inhibitors or ARBs, and coronary revascularization procedures. Another possibility is that 9795 are protective in healthy persons who do not have established cardiovascular 9795 but that their composition is altered in the presence of o belo na arte disease, rendering lei nonprotective lei at high levels or after therapeutic intervention.
Specifically, the composition and function of HDLs might have been altered in an adverse fashion after the qualifying acute coronary event, owing to the acute-phase response that occurs in the wake of myocardial infarction. Moreover, we observed codigo internacional de telefone do brasil an early harm nor a later benefit of treatment but rather a neutral effect of treatment 9795 an observation period of up to 3 years, well into the chronic phase of coronary lei disease, lei 9795 99.
Therefore, it is unlikely that dalcetrapib would have shown a benefit after an even longer period of follow-up. Finally, measurements of HDL cholesterol levels may not reflect the physiologic functions of HDLs, including reverse cholesterol transport. It is also possible that favorable effects of dalcetrapib with respect to HDL cholesterol were offset by other, unfavorable effects of treatment. The mean increase of 0. It is unlikely that a clinically meaningful benefit of dalcetrapib went undetected owing to a type 2 statistical error.
On the basis of the results observed for the primary efficacy measure, there is only a 1. Moreover, dalcetrapib had concordantly neutral effects on all components of the primary end point and on the rate of coronary revascularization.
In summary, the addition of dalcetrapib to standard therapy after an acute coronary syndrome raised the levels of HDL cholesterol and apolipoprotein A1 and had minimal effects on levels of LDL cholesterol and apolipoprotein B. In addition, triglyceride levels increased less in the dalcetrapib group than in the placebo group.
The risk of major cardiovascular outcomes was not significantly altered. It remains possible that agents that inhibit CETP and raise HDL cholesterol levels to a greater degree than did dalcetrapib and that also lower LDL cholesterol levels 31,33 will prove to have clinical effects different from those of dalcetrapib.
Schwartz reports receiving grant support on behalf of his institution from Anthera Pharmaceuticals, Resverlogix, Roche, and Sanofi; Dr. Chaitman, receiving consulting fees from Merck, Pfizer, and Abbott; Dr. Leitersdorf, serving on a board for and receiving consulting fees from Novartis and Merck, receiving lecture fees from Merck, and receiving grant support on behalf of his institution from Merck; Dr.
McMurray, receiving reimbursement for travel expenses from Roche and consulting fees on behalf of his institution from Roche; Dr. Shah, receiving consulting fees from Roche; Dr. Tardif, receiving lecture fees from Roche and Servier and grant support on behalf of his institution from Cerenis Therapeutics, Merck, Roche, and Servier; and Dr.
Wright, receiving fees for the development of educational presentations from Vindico Medical Education and consulting fees from Roche for himself and on behalf of his institution.
No other potential conflict of interest relevant to this article was reported. Disclosure forms provided by the authors are available with the full text of this 9795 at Lei.
We thank the patients who participated in this trial, the study coordinators, and the investigators see the Supplementary Appendix at all study sites. Address reprint requests to Dr. Endocrinol Metab Clin North Am ; Assmann G, Schulte H. Relation of high-density lipoprotein cholesterol and triglycerides to incidence of atherosclerotic coronary artery disease the PROCAM experience. Am J Cardiol ; High density lipoprotein as a protective factor against coronary heart disease: Am J Med ; Heart Protection Study Collaborative Group.
Efficacy and safety of cholesterol-lowering treatment: High-density lipoprotein, lei 9795 99, but not low-density lipoprotein cholesterol levels influence short-term prognosis after acute coronary syndrome: Eur Heart J ; Arterioscler Thromb Lei Biol ; On-treatment non-high-density lipoprotein cholesterol, apolipoprotein B, triglycerides, and lipid ratios in relation to residual vascular risk after treatment with potent statin therapy: Helena Zullo 11 Paes de Barros, Moóca — 11 Candido — 11 Juliana Cecheto — 11 Marcos Trench — 11 Maria Carolina Ochsendorf 11 Roberta — 11 Rosana Simon Halasz — 11 Ana Maria Correa — 11 Fabio Cechini Bianchi — 11 Adriana Valentim — 11 Camila 9795 da 9795 — 11 Cideli De Paula Coelho — 11 Henrique Marçal Lei 11 Lisandra de Lei Pinheiro Santos 11 Roberta Consani — 11 Rosana Simon Simulado prova escrita detran go 11 Osvaldo Pasqualin — 11 Exotic Pets transformar amperes em kw 11 Antônio de Macedo Soares, — Campo Belo http: Parada dos Bichos — 11 lei VilaVet — Clínica — 11 Paulista — 11 Roberto July — 11 Jurucê, — Indianópolis — Moema — pula pula mothibi. Hanellore 9795 — petsmile yahoo.
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