Darapladib for Preventing Ischemic Events in Stable Coronary Heart Disease
Open accessAbstract
BACKGROUND: Elevated lipoprotein-associated phospholipase A2 activity promotes the development of vulnerable atherosclerotic plaques, and elevated plasma levels of this enzyme are associated with an increased risk of coronary events. Darapladib is a selective oral inhibitor of lipoprotein-associated phospholipase A2. METHODS: In a double-blind trial, we randomly assigned 15,828 patients with stable coronary heart disease to receive either once-daily darapladib (at a dose of 160 mg) or placebo. The primary end point was a composite of cardiovascular death, myocardial infarction, or stroke. Secondary end points included the components of the primary end point as well as major coronary events (death from coronary heart disease, myocardial infarction, or urgent coronary revascularization for myocardial ischemia) and total coronary events (death from coronary heart disease, myocardial infarction, hospitalization for unstable angina, or any coronary revascularization). RESULTS: During a median follow-up period of 3.7 years, the primary end point occurred in 769 of 7924 patients (9.7%) in the darapladib group and 819 of 7904 patients (10.4%) in the placebo group (hazard ratio in the darapladib group, 0.94; 95% confidence interval [CI], 0.85 to 1.03; P=0.20). There were also no significant between-group differences in the rates of the individual components of the primary end point or in all-cause mortality. Darapladib, as compared with placebo, reduced the rate of major coronary events (9.3% vs. 10.3%; hazard ratio, 0.90; 95% CI, 0.82 to 1.00; P=0.045) and total coronary events (14.6% vs. 16.1%; hazard ratio, 0.91; 95% CI, 0.84 to 0.98; P=0.02). CONCLUSIONS: In patients with stable coronary heart disease, darapladib did not significantly reduce the risk of the primary composite end point of cardiovascular death, myocardial infarction, or stroke. (Funded by GlaxoSmithKline; STABILITY ClinicalTrials.gov number, NCT00799903.).
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No change in Lp-PLA2 over time was observed in placebo arms of trials of Lp-PLA2 inhibitors or in studies of Lp-PLA2 stability.
“Furthermore, no change in Lp-PLA2 over time was observed in the placebo arms of trials evaluating potential inhibitors of this pathway 18,19 or in studies of stability of circulating Lp-PLA2 levels over time.20”
From Effects of Randomized Treatment With Icosapent Ethyl and a Mineral Oil Comparator on Interleukin-1β, Interleukin-6, C-Reactive Protein, Oxidized Low-Density Lipoprotein Cholesterol, Homocysteine, Lipoprotein(a), and Lipoprotein-Associated Phospholipase A2: A REDUCE-IT Biomarker Substudy (2022) · cites this paper as [18]
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- Authors
- The STABILITY Investigators
- Affiliations
- University of Auckland (NZ)
- Corresponding author
- The STABILITY Investigators
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2014-05
- Volume
- 370
- Issue
- 18
- Pages
- 1702-1711
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W1572528121
- Cited by
- 579
- References
- 22
- Citations by year
- 2026: 23 · 2025: 34 · 2024: 33 · 2023: 27 · 2022: 47 · 2021: 38 · 2020: 34 · 2019: 36 · 2018: 48 · 2017: 63 · 2016: 71 · 2015: 85 · 2014: 37 · 2012: 1
- FWCI
- 85.88
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- RECERCAT (Consorci de Serveis Universitaris de Catalunya) (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- KTH Publication Database DiVA (KTH Royal Institute of Technology) (submittedVersion, other-oa)
- Dipòsit Digital de la Universitat de Barcelona (Universitat de Barcelona) (submittedVersion, public-domain)
- The HKU Scholars Hub (University of Hong Kong) (submittedVersion)
- Pure Amsterdam UMC (submittedVersion)
- Spiral (Imperial College London) (submittedVersion)
- UEA Digital Repository (University of East Anglia) (submittedVersion)
- Funders
- Uppsala Universitet
- Topics
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Life Sciences › Immunology and Microbiology › Immunology › Atherosclerosis and Cardiovascular Diseases
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Clinical Biochemistry › Paraoxonase enzyme and polymorphisms
- Keywords
- darapladib, lipoprotein-associated phospholipase A2, stable coronary artery disease, cardiovascular events, myocardial infarction, stroke, cardiovascular mortality, major coronary events, all-cause mortality, atherosclerotic plaque vulnerability, lipid-lowering therapy, unstable angina
- MeSH terms
- Aged, Benzaldehydes, Biphenyl Compounds, Coronary Artery Disease, Coronary Disease, Diethylamines, Double-Blind Method, Female, Follow-Up Studies, Humans, Male, Middle Aged, Myocardial Infarction, Oximes, Pyrimidinones, Sulfides, Treatment Failure, Stroke, Kaplan-Meier Estimate, Phospholipase A2 Inhibitors
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