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Update in General Internal Medicine: Evidence Published in 2011

Robert C. Brooks, MD, PhD; Peggy B. Hasley, MD, MHSc; Harish Jasti, MD; and David Macpherson, MD, MPH
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From the University of Pittsburgh School of Medicine, Veterans Affairs Pittsburgh Healthcare System, and the 4th Veterans Integrated Service Network, Pittsburgh, Pennsylvania.

Acknowledgment: The authors thank Christine Brush for her exceptional organizational work in preparing this Update and the members of the Division of General Internal Medicine Journal Club at the University of Pittsburgh for their input about the appropriateness of journal articles to include in the Update.

Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-0186.

Requests for Single Reprints: David Macpherson, MD, MPH, 323 North Shore Drive, Suite 400, Pittsburgh, PA 15212; e-mail, mailto:David.Macpherson@va.gov.

Current Author Addresses: Dr. Brooks: Pittsburgh VA Healthcare System, University Drive C, 130-U, Pittsburgh, PA 15240.

Dr. Hasley: University of Pittsburgh, 200 Lothrop Street, Pittsburgh, PA 15213.

Dr. Jasti: University of Pittsburgh, 200 Lothrop Street, MUH 9W33, Pittsburgh, PA 15213.

Dr. Macpherson: University of Pittsburgh, 323 North Shore Drive, Suite 400, Pittsburgh, PA 15212.

Author Contributions: Conception and design: P.B. Hasley, H. Jasti, D. Macpherson.

Analysis and interpretation of the data: R.C. Brooks, P.B. Hasley, H. Jasti, D. Macpherson.

Drafting of the article: R.C. Brooks, P.B. Hasley, H. Jasti, D. Macpherson.

Critical revision of the article for important intellectual content: R.C. Brooks, P.B. Hasley, H. Jasti, D. Macpherson.

Final approval of the article: R.C. Brooks, P.B. Hasley, H. Jasti, D. Macpherson.

Administrative, technical, or logistic support: D. Macpherson.

Collection and assembly of data: R.C. Brooks, P.B. Hasley, H. Jasti, D. Macpherson.

Ann Intern Med. 2012;156(9):649-653. doi:10.7326/0003-4819-156-9-201205010-00410
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This Update summarizes studies published in 2011 that the authors consider highly relevant to the practice of general internal medicine. Topics include hyperlipidemia, anticoagulation and thromboembolism, cancer screening and prevention, and hypertension.

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Update in General Internal Medicine: Evidence Published in 2011
Posted on May 28, 2012
Sunder M., Lal, Nephrologist
Boone Hospital Center, Columbia, MO
Conflict of Interest: None Declared

The AIM-HIGH Investigators. Niacin in patients with low HDL cholesterol levels receiving intensive Statin therapy.

The observed results in this study may be due to flaws in the study design. The given placebo contained crystalline niacin and patients in the control group may have received up to 200mg of niacin a day; 20% of patients in both groups were on niacin prior to randomization. Ezetimibe was also used in both groups; no vascular studies were undertaken (1). Significant increases in HDL levels were previously reported with the use of 100 mg of niacin (2). In the Coronary Drug Project Patients treated with niacin showed a decrease in nonfatal recurrent MI and lower mortality nearly 9 years after termination of study (3). Therefore, it is plausible that no beneficial effects were seen between the treatment groups in the present study.

Were there any outcome differences in a sub group of patients who were on (a) Roziglitazone (4) or (b) who had comparable duration of co- morbid variables and never received prior niacin treatment? Randomized trials with (IR) nicotinic acid added to a Statin are needed before making a final judgment on retiring niacin (5)


(1). The AIM-HIGH Investigators. Niacin in patients with low HDL cholesterol levels receiving intensive Statin therapy. N Engl J Med 2011;365: 2255-2267.

(2). Wink J, Giacoppe G, King J. Effect of very-low-dose niacin on high-density lipoprotein in patients undergoing long-term statin therapy. Am Heart J 2002; 143: 514-8.

(3). Canner PL, Berge KG, Wenger NK, et al. Fifteen year mortality in Coronary Drug Project patients: long-term benefit with niacin. J Am Coll Cardiol 1986; 8: 1245-55.

(4). Nissen S, Wolski K: Effect of Rosiglitazone on the risk of myocardial infarction and death from cardiovascular causes. N Engl J Med. 2007;356(24):2457-2471.

(5). Giugliano, R: Niacin at 56 Years of Age -- Time for an Early Retirement? N Engl J Med 2011; 365:2318-2320.

Sunder M. Lal, M.D. 1100 Club Village Drive Ste 102 Columbia, MO 65203 573-447-4400

Conflict of Interest:

None declared

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