Cited by 2,022Lipoproteins and Cardiovascular HealthCholesterol and Lipid MetabolismParaoxonase enzyme and polymorphisms

Effects of dalcetrapib in patients with a recent acute coronary syndrome

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Schwartz, Gregory G., Olsson, Anders G., Abt, Markus, Ballantyne, Christie M., Barter, Philip J., Brumm, Jochen, Chaitman, Bernard R., Holme, Ingar M. +9 more·2012·New England Journal of Medicine

Abstract

BACKGROUND: In observational analyses, higher levels of high-density lipoprotein (HDL) cholesterol have been associated with a lower risk of coronary heart disease events. However, whether raising HDL cholesterol levels therapeutically reduces cardiovascular risk remains uncertain. Inhibition of cholesteryl ester transfer protein (CETP) raises HDL cholesterol levels and might therefore improve cardiovascular outcomes. METHODS: We randomly assigned 15,871 patients who had had a recent acute coronary syndrome to receive the CETP inhibitor dalcetrapib, at a dose of 600 mg daily, or placebo, in addition to the best available evidence-based care. The primary efficacy end point was a composite of death from coronary heart disease, nonfatal myocardial infarction, ischemic stroke, unstable angina, or cardiac arrest with resuscitation. RESULTS: At the time of randomization, the mean HDL cholesterol level was 42 mg per deciliter (1.1 mmol per liter), and the mean low-density lipoprotein (LDL) cholesterol level was 76 mg per deciliter (2.0 mmol per liter). Over the course of the trial, HDL cholesterol levels increased from baseline by 4 to 11% in the placebo group and by 31 to 40% in the dalcetrapib group. Dalcetrapib had a minimal effect on LDL cholesterol levels. Patients were followed for a median of 31 months. At a prespecified interim analysis that included 1135 primary end-point events (71% of the projected total number), the independent data and safety monitoring board recommended termination of the trial for futility. As compared with placebo, dalcetrapib did not alter the risk of the primary end point (cumulative event rate, 8.0% and 8.3%, respectively; hazard ratio with dalcetrapib, 1.04; 95% confidence interval, 0.93 to 1.16; P=0.52) and did not have a significant effect on any component of the primary end point or total mortality. The median C-reactive protein level was 0.2 mg per liter higher and the mean systolic blood pressure was 0.6 mm Hg higher with dalcetrapib as compared with placebo (P<0.001 for both comparisons). CONCLUSIONS: In patients who had had a recent acute coronary syndrome, dalcetrapib increased HDL cholesterol levels but did not reduce the risk of recurrent cardiovascular events. (Funded by F. Hoffmann-La Roche; dal-OUTCOMES ClinicalTrials.gov number, NCT00658515.).

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Crossref · 10.1056/nejmoa1206797

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  • Attenuation of statin treatment intensity probably also contributed to the rise in LDL cholesterol observed in the placebo group, in the on-treatment analysis in the alirocumab group, and in previous trials involving patients with acute coronary syndrome.

    “The last factor probably also contributed to the rise in LDL cholesterol observed in the placebo group, in the on-treatment analysis in the alirocumab group, and in previous trials involving patients who had an acute coronary syndrome. 5,21”

    From Alirocumab and Cardiovascular Outcomes after Acute Coronary Syndrome (2018) · cites this paper as [21]

    The Study Population section confirms that this was a trial involving patients with a recent acute coronary syndrome, and the Lipoproteins and Glycemic Control section reports LDL-cholesterol measurements. Neither section says that statin treatment intensity declined or that such a decline contributed to a rise in LDL cholesterol. No page number is available in our copy. (LLM, conf=0.76)

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  • Three large randomized controlled trials of cholesterol ester transfer protein inhibitors did not improve cardiovascular outcomes despite substantial increases in plasma HDL-C levels.

    “three large RCTs of cholesterol ester transfer protein inhibitors (dalcetrapib, evacetrapib, and torcetrapib) did not improve CV outcomes despite substantial increases in plasma HDL-C levels”

    From The Forgotten Lipids: Triglycerides, Remnant Cholesterol, and Atherosclerotic Cardiovascular Disease Risk (2019) · cites this paper as [21]

    The Results and Discussion report that dalcetrapib substantially raised HDL cholesterol without improving major cardiovascular outcomes. The introductory text (p. 2090) reports increased HDL cholesterol but excess morbidity and mortality with torcetrapib. The paper does not report cardiovascular-outcome results for evacetrapib; it appears only as a lipid-level trial in the References. (LLM, conf=0.90)

    Experimental — accuracy not yet measured
  • Early generations of CETP inhibitors were either associated with off-target adverse effects with safety concerns, or had no significant or only modest LDL-C lowering and thus failed to demonstrate cardiovascular benefit.

    “Unfortunately, early generations of CETP inhibitors were either associated with off-target adverse effects with safety concerns, or had no significant or only modest LDL-C lowering and thus failed to demonstrate cardiovascular benefit, leading to a loss of enthusiasm in this drug class [[7], [8], [9], [10]].”

    From Efficacy and safety of obicetrapib in patients with dyslipidemia: An updated meta-analysis of randomized controlled trials (2025) · cites this paper as [8]

    The introduction (p. 2090) reports excess morbidity and mortality with torcetrapib associated with elevated aldosterone and blood pressure. The Discussion reports that dalcetrapib had minimal LDL-C effects and no significant cardiovascular benefit, but it does not establish that weak LDL-C lowering caused that outcome. It also cautions that the adverse effects observed across inhibitors may reflect CETP inhibition rather than drug-specific off-target effects. (LLM, conf=0.84)

    Experimental — accuracy not yet measured
  • There is no evidence from randomized trials that therapeutically increasing plasma HDL-C reduces cardiovascular event risk.

    “Furthermore, there is no evidence from randomized trials that therapeutically increasing plasma HDL-C reduces the risk of CV events [63-67].”
  • In ACCELERATE and REVEAL, CETP inhibitors more than doubled HDL-C but did not reduce atherosclerotic cardiovascular disease events beyond that expected from modest ApoB reductions.

    “Similarly, in the Assessment of Clinical Effects of Cholesteryl Ester Transfer Protein Inhibition with Evacetrapib in Patients at a High-Risk for Vascular Outcomes (ACCELERATE) and Randomized Evaluation of the Effects of Anacetrapib Through Lipid Modification (REVEAL) trials, treatment with CETP inhibitors more than doubled HDL-C levels, but did not appear to reduce the risk of ASCVD events beyond”

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2 of the 35 references couldn’t be matched to a known paper.

Research works printed but not linked: 3

  1. [14]14. Erratum, N Engl J Med 2010;362:1748.]
  2. [21]21. Voight BF, Peloso GM, Orho-Melander M, et al. Plasma HDL cholesterol and risk of myocardial infarction: a mendelian randomisation study. Lancet 2012;380: 572-80. [Erratum, Lancet 2012;380:564.]
  3. [25]25. Stein EA, Stroes ES, Steiner G, et al. Safety and tolerability of dalcetrapib. Am J Cardiol 2009;104:82-91.

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Authors
Schwartz, G. G., Olsson, A. G., Abt, M., Ballantyne, C. M., Barter, P. J., Brumm, J., Chaitman, B. R., Holme, I. M., Kallend, D., Leiter, L. A., Leitersdorf, E., McMurray, J. J. V., Mundl, H., Nicholls, S. J., Shah, P. K., Tardif, J.-C., & Wright, R. S.
Affiliations
  • Denver VA Medical Center (US)
  • Linköping University (SE)
  • F. Hoffmann-La Roche AG (CH)
  • Baylor College of Medicine (US)
  • University of Zurich (CH)
  • Oslo University Hospital (NO)
  • St. Michael's Hospital (CA)
  • Mayo Clinic (US)
Venue
New England Journal of Medicine
Published
2012-11-29
Volume
367
Issue
22
Pages
2089-2099
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
OpenAlex
W2118825330
Cited by
2,022
References
35
Citations by year
2026: 66 · 2025: 82 · 2024: 81 · 2023: 89 · 2022: 103 · 2021: 128 · 2020: 109 · 2019: 141 · 2018: 164 · 2017: 195 · 2016: 222 · 2015: 244 · 2014: 191 · 2013: 190 · 2012: 7
FWCI
206.17
Type
journal article
Language
en
Open access
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • Zurich Open Repository and Archive (University of Zurich) (acceptedVersion, other-oa)
  • ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (acceptedVersion)
  • Research Bank (Australian Catholic University) (submittedVersion)
  • Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
  • Archivio Istituzionale della Ricerca - Università degli Studi della Campania "Luigi Vanvitelli" (submittedVersion)
  • Zurich Open Repository and Archive (University of Zurich) (submittedVersion, other-oa)
  • Zurich Open Repository and Archive (University of Zurich)
Funders
  • Amgen
  • Bristol-Myers Squibb
  • Eli Lilly and Company
  • Pfizer
  • AstraZeneca
  • GlaxoSmithKline
  • Sanofi
  • F. Hoffmann-La Roche
  • CSL Behring
  • Amarin Corporation
  • Anthera
  • Kowa Company
  • Servier
  • Esperion Therapeutics
  • Genentech
Topics
  • Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
  • Health Sciences › Medicine › Surgery › Cholesterol and Lipid Metabolism
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Clinical Biochemistry › Paraoxonase enzyme and polymorphisms
Keywords
dalcetrapib, cholesteryl ester transfer protein inhibition, HDL cholesterol, acute coronary syndrome, cardiovascular risk, futility, LDL cholesterol, C-reactive protein, systolic blood pressure, myocardial infarction, ischemic stroke, unstable angina, cardiovascular mortality, lipid-lowering therapy
MeSH terms
Aged, Amides, Anticholesteremic Agents, Apolipoproteins, Blood Pressure, C-Reactive Protein, Cardiovascular Diseases, Esters, Female, Humans, Cholesterol, HDL, Cholesterol, LDL, Male, Middle Aged, Risk, Sulfhydryl Compounds, Triglycerides, Biomarkers, Cholesterol Ester Transfer Proteins, Acute Coronary Syndrome, Secondary Prevention

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