CardioExchange Archive

The final results of the ARBITER 6-HALTS trial, which provoked an explosion of controversy upon initial publication last November, have now been published in the Journal of the American College of Cardiology. The trial compared ezetimibe to extended-release niacin in high-risk patients already taking statins. Villines et al. report the CIMT results on 315 patients enrolled in the trial — 208 who completed the full 14-month follow-up prior to the trial’s early termination, and 107 who had a mean treatment period of 7 months.
   Ezetimibe treatment did not reduce either mean CIMT or maximal CIMT compared to baseline measurements. By contrast, extended-release niacin resulted in significant reductions in mean CIMT and maximal CIMT compared to baseline. In addition, the trial investigators wrote that a strong “relationship between cumulative drug exposure and the CIMT effect” of niacin “supports an expected, direct relationship between increasing intensity of drug exposure (through a composite of dose, adherence, and time) and its effect on atherosclerosis.” In sharp contrast, “findings with ezetimibe [show] an unexpected inverse relationship between intensity of drug exposure and CIMT.”
Click here to view blogs and discussions about ARBITER 6-HALTS on CardioExchange.

Malpractice and Regional Variation: Fear of malpractice may help explain regional differences in healthcare utilization, including cardiac catheterization, according to a report in Circulation: Cardiovascular Quality and Outcomes. Lucas and colleagues asked 598 cardiologists “under what circumstances they would order a cardiac catheterization ‘for other than purely clinical reasons’.” Some 27% of the cardiologists said they would order a catheterization if they believed a colleague would do the same in a similar circumstance, and 24% said they would do so out of fear of malpractice.