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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThe Stability of Atherosclerotic Plaque by Initiation of Darapladib Therapy trial [STABILITY; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00799903\u0026amp;atom=%2Fspmdc%2F14%2F27%2F28.atom\u0022\u003ENCT00799903\u003C\/a\u003E] showed that darapladib compared with placebo, did not significantly reduce the composite primary end point of cardiovascular death, myocardial infarction, and stroke in 15?828 patients with stable coronary heart disease on optimal medical therapy [White HD et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E. 2014]. This article presents data from a predefined analysis of STABILITY designed to examine factors that contribute to high levels of Lp-PLA2 activity, whether its activity predicted outcomes or identified patients who would have a greater benefit with darapladib, and whether darapladib would provide persistent, long-term reduction of Lp-PLA2 activity.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECoronary Artery Disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECoronary Artery Disease\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EThe Stability of Atherosclerotic Plaque by Initiation of Darapladib Therapy trial [STABILITY; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00799903\u0026amp;atom=%2Fspmdc%2F14%2F27%2F28.atom\u0022\u003ENCT00799903\u003C\/a\u003E] showed that darapladib, an oral inhibitor of lipoprotein-associated phospholipase A\u003Csub\u003E2\u003C\/sub\u003E (Lp-PLA\u003Csub\u003E2\u003C\/sub\u003E), compared with placebo, did not significantly reduce the composite primary end point of cardiovascular (CV) death, myocardial infarction (MI), and stroke (HR, 0.94; 95% CI, 0.85 to 1.03; \u003Cem\u003EP\u003C\/em\u003E = .20) in 15 828 patients with stable coronary heart disease (CHD) on optimal medical therapy [White HD et al. \u003Cem\u003EN Engl J Med.\u003C\/em\u003E 2014]. The mean follow-up duration was 3.7 years. The secondary end point of major coronary events (CHD death, MI, and urgent coronary revascularization) was significantly reduced with treatment versus placebo (HR, 0.90; 95% CI, 0.82 to 1.00; \u003Cem\u003EP\u003C\/em\u003E = .045).\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003ELars Wallentin, MD, PhD, Uppsala Clinical Research Center, Uppsala, Sweden, presented data from a predefined analysis of STABILITY designed to examine factors that contribute to high levels of Lp-PLA\u003Csub\u003E2\u003C\/sub\u003E activity, whether its activity predicted outcomes or identified patients who would have a greater benefit with darapladib, and whether darapladib would provide persistent, long-term reduction of Lp-PLA\u003Csub\u003E2\u003C\/sub\u003E activity.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EFor this analysis, blood samples were collected at baseline from 14 500 patients; of these, samples were also collected at all follow-up visits (months 1, 3, 6, and 18 and end of treatment) in 100 patients. The mean activity level of Lp-PLA\u003Csub\u003E2\u003C\/sub\u003E was 172 nmol\/min\/mL, with a normal distribution in relation to baseline demographics. The patients were evenly divided by tertiles of Lp-PLA\u003Csub\u003E2\u003C\/sub\u003E activity (tertile 1, \u2265 153.6 nmol\/min\/mL; tertile 2, 153.7\u2013192.5 nmol\/min\/mL; tertile 3, \u0026gt; 192.5 nmol\/min\/mL).\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EThe baseline characteristics and biomarkers that increased or decreased Lp-PLA\u003Csub\u003E2\u003C\/sub\u003E activity on multivariate analysis are shown in \u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E. In the subset of 100 patients, there was a 65% relative risk reduction in Lp-PLA\u003Csub\u003E2\u003C\/sub\u003E activity with darapladib that was seen 1 month after treatment began and persisted through the end of follow-up.\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/14988\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/14988\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/14988\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-6\u0022 class=\u0022first-child\u0022\u003EEffect of Baseline Characteristics and Biomarkers on Lp-PLA\u003Csub\u003E2\u003C\/sub\u003E Activity on Multivariate Analysis\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-9\u0022\u003EFor the primary end point, the baseline level of Lp-PLA\u003Csub\u003E2\u003C\/sub\u003E activity predicted an increased risk for events, with a significant increase in tertile 3 versus tertile 1 (\u003Cem\u003EP\u003C\/em\u003E \u0026lt; .001) and a nonsignificant (NS) increase in tertile 2 versus tertile 1 (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E). A similar prognostic effect was seen for the secondary end point of major coronary events for tertile 3 versus tertile 1 (HR, 1.52; 95% CI, 1.34 to 1.73; \u003Cem\u003EP\u003C\/em\u003E \u0026lt; .001) and tertile 2 versus tertile 1 (HR, 1.12; 95% CI, 0.97 to 1.28; \u003Cem\u003EP\u003C\/em\u003E = NS).\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/27\/28\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Lp-PLA2 Activity in Relation to Primary Outcome\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1340071334\u0022 data-figure-caption=\u0022\u0026amp;lt;div xmlns=\u0026amp;quot;http:\/\/www.w3.org\/1999\/xhtml\u0026amp;quot;\u0026amp;gt;Lp-PLA\u0026amp;lt;sub\u0026amp;gt;2\u0026amp;lt;\/sub\u0026amp;gt; Activity in Relation to Primary Outcome\u0026amp;lt;\/div\u0026amp;gt;\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/27\/28\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/27\/28\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/27\/28\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/14987\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-10\u0022 class=\u0022first-child\u0022\u003ELp-PLA\u003Csub\u003E2\u003C\/sub\u003E Activity in Relation to Primary Outcome\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EC V, card iovascu la r; Lp-PL A\u003Csub\u003E2\u003C\/sub\u003E, lipoprotein-associated phospholipase A\u003Csub\u003E2\u003C\/sub\u003E; MI, myocardial infarction.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003EReproduced with permission from L Wallentin, MD, PhD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-11\u0022\u003ENo relation was found between treatment with darapladib and the composite primary or secondary outcomes in any tertile of Lp-PLA\u003Csub\u003E2\u003C\/sub\u003E activity (\u003Ca id=\u0022xref-table-wrap-2-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T2\u0022\u003ETable 2\u003C\/a\u003E).\u003C\/p\u003E\u003Cdiv id=\u0022T2\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/14989\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/14989\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/14989\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 2.\u003C\/span\u003E \n            \u003Cp id=\u0022p-12\u0022 class=\u0022first-child\u0022\u003ETreatment Outcomes in Relation to Lp-PLA\u003Csub\u003E2\u003C\/sub\u003E Activity\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-15\u0022\u003EIn addition to traditional risk factors that increased the risk for a primary outcome event, Lp-PLA\u003Csub\u003E2\u003C\/sub\u003E activity increased this risk (tertile 3 vs tertile 1; HR, 1.45; 95% CI, 1.25 to 1.69; \u003Cem\u003EP\u003C\/em\u003E \u0026lt; .001). Darapladib versus placebo treatment did not influence the risk for the primary outcome (HR, 0.92; 95% CI, 0.83 to 1.03; \u003Cem\u003EP\u003C\/em\u003E = .14).\u003C\/p\u003E\u003Cp id=\u0022p-16\u0022\u003EThis analysis of the STABILITY study showed that Lp-PLA\u003Csub\u003E2\u003C\/sub\u003E activity is an independent predictor of CV events, but its baseline activity did not predict the effect of darapladib on coronary events.\u003C\/p\u003E\u003Cp id=\u0022p-17\u0022\u003EFurther evaluation is needed to determine the value of measuring Lp-PLA\u003Csub\u003E2\u003C\/sub\u003E activity to predict CV risk in the absence of an indication for a specific treatment, stated Prof Wallentin.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/27\/28.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzoule\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzoule\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzoule\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}