Private practice with Dr Seth Bilazarian

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Learning from AIM-HIGH

May 26, 2011 11:15 EDT


Just stopped by the NHLBI, the AIM-HIGH trial failed to establish the advantage of adding high-dose, extended-release niacin to statin treatment. AIM-HIGH sought to confirm previous smaller trials—and the hunch of many practitioners—but the surprising results underline the importance of randomized clinical trials. What have you learned from the AIM-HIGH trial?

Disclosure: I was a clinical investigator for AIM-HIGH

See:

NIH pulls plug on AIM-HIGH trial with niacin





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Your comments
Learning from AIM-HIGH
# 1 of 3
June 1, 2011 11:01 (EDT)
Bryan
So does this mean in your practice you are going d/c niacin on all of your patients currently taking the drug?
# 2 of 3
June 2, 2011 09:45 (EDT)
silvio paffer

Despite the negative findings of AIM HIGH, what about the positive effects of niacin on intima-media tickenning in diabetic patients ? Should we only use statins? And those patients who can´t tolerate statins because of muscle pain - isn´t it a good indication?

Please share comments on this!
# 3 of 3
June 5, 2011 01:36 (EDT)
Peter Richardson

HELLO>

 

I have used FREE Niacin since well before Niacin.

 

I continued to increase the dose until "NO" flushing occured.

We stopped one case for gout.

I had one lass on 9 Gns for Niacin with out adverse symptoms, lab or clinical.

If there were symptoms of flushing in anyone in the trial, the dose (which is individualized) was insufficient.

As such, it was not a good trial.

Re-read the "HOT" study where medication dose was changed until goal(inthis case NO flushinh) was reached.

I still use Niacin (cheap) in low HDL &/or high TG patients...dosing to a point where there is no longer flushing.

Sincerely, Peter richardson MD FRCP

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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.