Private practice with Dr Seth Bilazarian

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ARBITER 6-HALTS: What are the clinical implications?

Nov 18, 2009 12:45 EST


In this trial extended-release niacin was shown to be superior to ezetimibe with a surrogate endpoint of carotid IMT. As we wait for more complete data from the AIM-HIGH and IMPROVE-IT trials, how will the results of ARBITER 6-HALTS affect your daily practice? Will you use potent statins more and zetia less while we wait until 2012 for the IMPROVE-IT study?

See:

ARBITER 6-HALTS: HDL raising with niacin superior to ezetimibe

Ezetimibe in ARBITER 6-HALTS: What lessons can we learn?

ARBITER 6-HALTS: Will you refill or newly prescribe ezetimibe/Zetia after today?





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Your comments
ARBITER 6-HALTS: What are the clinical implications?
# 1 of 2
November 19, 2009 04:43 (EST)
W.E. Feeman, Jr, MD
CIMT may not be the best surrogate marker, since it measures both the intima and the media as a single reading and since atherosclerosis is an intimal event and is related to dyslipidemia and cigarette smoking, whereas the media is not the primary area for the atherosclerotic process and is influenced by other factors such as blood pressure, obesity.  If Zetia fails to reduce plaque on an IVUS study, then I would want to see what it is about Zetia that prevents the LDL-lowering effect on plaque from occuring.  I personally do not use Zetia any longer because of the cancer effect, which I believe is real despite Merck's whitewash.
# 2 of 2
December 10, 2009 12:44 (EST)
H. F. Fritz

The track record of excellent correlation between carotid IMT and coronary IVUS responses in clinical trials is to me a strong support of the validity of Arbiter-6 Halts conclusions.  I will expect an IVUS study of the same meds as Arbiter used to show similar results. 


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About Dr Seth Bilazarian
Seth Bilazarian MD has been a Clinical and Interventional Cardiologist at Pentucket Medical Associates in Massachusetts since 1993. He is board certified in Internal Medicine, Cardiovascular Medicine, Nuclear Cardiology, Vascular Ultrasound, Interventional Cardiology, and Vascular and Endovascular Medicine.

Dr Bilazarian performs coronary and peripheral interventions at Lahey Clinic and Massachusetts General Hospital. He has been an investigator in the interventional laboratory for new devices including drug-eluting stents, distal protection devices, imaging devices (OCT and InfraRed), and anticoagulant pharmacotherapy.

Dr Bilazarian is an active participant in clinical trials in congestive heart failure, hypertension, coronary disease prevention, prediabetes management, anemia, atrial fibrillation, and anticoagulation/antiplatelet therapies in the outpatient setting. He has authored numerous papers and book chapters in clinical cardiology. He was appointed as a physician advisor to the circulatory device panel of the FDA in 2008.
About this blog
My intent is to create a forum for dialogue on issues pertinent to private practice cardiology around topics such as:

  • Integration of new data and guidelines on inpatient and outpatient practice in clinical and interventional cardiology
  • Practice approaches to the extra clinical issues in dealing with managed care insurers
  • Strategies for navigating the restrictions of pharmacy benefits managers (PBMs) on pharmacologic therapies for our patients
  • Experiences with restrictions on testing and imaging
The video blog (VLOG) will provide an opportunity to share broadly different approaches to the common conundrums we face in caring for patients. My hope is that this forum will provide useful data points for practice outside of tertiary and academic centers and a look inside community hospitals and physician?s practice patterns in the office, starting with mine.