Evacetrapib
In the ACCELERATE diabetes cohort, higher baseline HbA1c independently predicted cardiovascular events despite statin therapy (J Am Heart Assoc 2020)
Original title: Impact of Baseline Glycemic Control on Residual Cardiovascular Risk in Patients With Diabetes Mellitus and High-Risk Vascular Disease Treated With Statin Therapy
Among 8,145 patients with diabetes and measured HbA1c enrolled in the ACCELERATE trial of evacetrapib, this analysis tested whether baseline glycaemic control predicted the composite endpoint of cardiovascular death, non-fatal myocardial infarction, stroke, hospitalisation for unstable angina, and coronary revascularisation. Increasing baseline HbA1c was strongly associated with the primary composite endpoint (Kaplan-Meier estimate range 12.6 to 18.2%, P < 0.001), the triple endpoint of death, myocardial infarction and stroke (P = 0.003), and individually with myocardial infarction, unstable angina hospitalisation and revascularisation, though not stroke or mortality. After adjustment, baseline HbA1c remained an independent predictor of the primary endpoint (hazard ratio 1.06, 95% CI, 1.02 to 1.11, P = 0.003). The authors conclude glycaemic control remains strongly and independently linked to cardiovascular outcomes in high-risk statin-treated diabetes patients, an analysis using the ACCELERATE evacetrapib trial cohort rather than a report on evacetrapib itself.
Original abstract
Background The contemporary impact of glycemic control on patients with diabetes mellitus at high cardiovascular risk remains unclear. We evaluated the utility of hemoglobin A1c (HbA1c) as a marker of risk on the composite end point of cardiovascular death, nonfatal myocardial infarction, stroke, hospitalization for unstable angina, and coronary revascularization in an optimally treated population with diabetes mellitus and established coronary artery disease enrolled in the ACCELERATE (Assessment of Clinical Effects of Cholesteryl Ester Transfer Protein Inhibition With Evacetrapib in Patients at a High Risk for Vascular Outcomes) trial. Methods and Results We included all patients with established diabetes mellitus and measured HbA1c (N=8145) and estimated Kaplan-Meier (KM) events rates, stratified by increasing baseline HbA1c levels censored at 30 months. We then performed a multivariable regression for the primary end point. Increasing baseline HbA1c was strongly associated with the occurrence of the primary end point (KM estimate, 12.6-18.2; P<0.001). Increasing baseline HbA1c was also associated with the triple end point of death, nonfatal myocardial infarction, and stroke (KM estimate, 7.8-11.3; P=0.003) as well as the individual end points of nonfatal myocardial infarction (KM estimate, 3.1-7.0; P<0.001), hospitalization for unstable angina (KM estimate, 1.8-5.0; P=0.003), and revascularization (KM estimate, 7.3-11.1; P=0.001), although not stroke (KM estimate, 1.4-2.4; P=0.45). The rates of cardiovascular mortality (KM estimate, 2.6-4.3; P=0.21) and all-cause mortality (KM estimate, 4.8-5.9; P=0.21) were similar regardless of baseline HbA1c levels. When adjusting for relevant baseline characteristics, baseline HbA1c was an independent predictor for the primary end point (hazard ratio, 1.06; 95% CI, 1.02-1.11; P=0.003). Conclusions Glycemic control, as measured by HbA1c, remains strongly and independently associated with cardiovascular outcomes in high-risk patients with diabetes mellitus on statin therapy. Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT01687998.
diabetesevacetrapiboutcomes trials
Summary written by cetpinhibition.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.