{"id":14002,"date":"2011-11-16T14:37:16","date_gmt":"2011-11-16T19:37:16","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?post_type=fellowship-training&p=14002"},"modified":"2011-11-16T14:37:19","modified_gmt":"2011-11-16T19:37:19","slug":"was-aim-high-a-hit-or-a-miss","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2011\/11\/16\/was-aim-high-a-hit-or-a-miss\/","title":{"rendered":"Was AIM HIGH a Hit or a Miss?"},"content":{"rendered":"

Several Cardiology Fellows who are attending AHA.11 this week are blogging together on CardioExchange.\u00a0 The Fellows include\u00a0Revathi Balakrishnan<\/a>,<\/a> Eiman Jahangir<\/a>, John Ryan<\/a> (moderator), and Amit Shah<\/a>. Read the previous post here<\/a>. Check back often to learn about the biggest buzz in Orlando.<\/em><\/p>\n

<\/em>In the weeks leading up to the AHA, there was much anticipation about the presentation of AIM HIGH amongst my co-fellows and attendings. \u00a0Prior to starting fellowship, I did an additional year of training in preventive medicine, so the evidence for (or against) HDL therapy is of particular interest to me. The details of the study were described earlier on CardioExchange<\/a> , but briefly, patients with cardiovascular disease, cerebrovascular disease or PAD with low HDL and elevated triglycerides were randomized to receive simvastatin combined with either niacin or placebo and were followed for differences in rates of cardiovascular events (CHD death, nonfatal MI, ischemic stroke, ACS, or revascularization). The trial was stopped early back in May, after 3 years of follow up, for \u201clack of efficacy\u201d and concern for ischemic stroke imbalance (although overall rates were low).\u00a0 In addition, there was no significant difference for secondary endpoints, for cardiovascular death alone, and no differences between prespecified subgroups (by age, gender, diabetes, metabolic syndrome, history of MI, or statin at entry).<\/p>\n

Sitting in the audience during the presentation, one could hear hushed rumblings throughout the crowd; the discussant, Dr. Philip Barter from The Heart Research Institute in Australia delivered probably the most dramatic commentary of the late breaking updates: \u201cThis study seriously disturbs me\u2026because it was designed in such a way that it was not possible to get a positive result\u2026\u201d See the CardioExchange summary<\/a> of the interaction.<\/p>\n

He astutely pointed out faults in the inherent design of the trial:<\/p>\n