Cardiovascular outcome trial · N Engl J Med 2017
REVEAL trial
Effects of Anacetrapib in Patients with Atherosclerotic Vascular Disease.
The bottom line
Adding the CETP inhibitor anacetrapib to intensive statin therapy modestly reduced major coronary events in patients with atherosclerotic vascular disease, without significant safety concerns.
BenefitUS status: Not marketed
At a glance
- Medicine
- 100 mg of anacetrapib once daily (15,225 patients), added to intensive atorvastatin therapy
- Compared with
- Matching placebo (plus intensive atorvastatin therapy)
- People
- 30,449
- Who took part
- Adults with atherosclerotic vascular disease receiving intensive atorvastatin therapy, mean LDL cholesterol 61 mg/dL, mean non-HDL cholesterol 92 mg/dL, mean HDL cholesterol 40 mg/dL
- Design
- Randomized, double-blind, placebo-controlled trial
- Follow-up
- median follow-up period of 4.1 years
- Main question
- First major coronary event, a composite of coronary death, myocardial infarction, or coronary revascularization
Main result
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
Effect on LDL cholesterol
Mean LDL cholesterol level at baseline was 61 mg per deciliter (1.58 mmol per liter); mean non-HDL cholesterol level was lower by 17 mg per deciliter (0.44 mmol per liter), a relative difference of -18%, in the anacetrapib group at the trial midpoint.
Other results
There were no significant between-group differences in the risk of death, cancer, or other serious adverse events.
Safety
There were no significant between-group differences in the risk of death, cancer, or other serious adverse events.
In the trial's own words
“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).”
Quoted from the abstract of N Engl J Med 2017, checked word for word against PubMed. PubMed 28847206 · Full paper (DOI)
Common questions
What did the REVEAL trial find?
Adding the CETP inhibitor anacetrapib to intensive statin therapy modestly reduced major coronary events in patients with atherosclerotic vascular disease, without significant safety concerns.
Who was in REVEAL?
30,449 people. Adults with atherosclerotic vascular disease receiving intensive atorvastatin therapy, mean LDL cholesterol 61 mg/dL, mean non-HDL cholesterol 92 mg/dL, mean HDL cholesterol 40 mg/dL.
What was REVEAL's main result?
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
How much did LDL cholesterol change in REVEAL?
Mean LDL cholesterol level at baseline was 61 mg per deciliter (1.58 mmol per liter); mean non-HDL cholesterol level was lower by 17 mg per deciliter (0.44 mmol per liter), a relative difference of -18%, in the anacetrapib group at the trial midpoint.
Related trials
- ACCELERATE (2017)Despite markedly improving LDL and HDL cholesterol levels, evacetrapib did not reduce cardiovascular events compared with placebo in high-risk vascular disease patients, and the trial was stopped early for futility.
- dal-OUTCOMES (2012)In patients with a recent acute coronary syndrome, dalcetrapib raised HDL cholesterol but did not reduce cardiovascular events or mortality compared with placebo.
- BROADWAY (2025)In high-risk patients already on maximum tolerated lipid-lowering therapy, adding obicetrapib 10 mg daily lowered LDL cholesterol by about 30% more than placebo with a similar rate of adverse events.
- BROOKLYN (2026)In patients with heterozygous familial hypercholesterolemia already on maximally tolerated lipid-lowering therapy, adding obicetrapib substantially lowered LDL cholesterol (and improved other lipid parameters) compared with placebo and was well tolerated.
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