{"id":44184,"date":"2014-07-21T16:32:10","date_gmt":"2014-07-21T20:32:10","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?post_type=voices&p=44184"},"modified":"2014-07-21T16:32:10","modified_gmt":"2014-07-21T20:32:10","slug":"selections-from-richard-lehmans-literature-review-july-14th-2","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2014\/07\/21\/selections-from-richard-lehmans-literature-review-july-14th-2\/","title":{"rendered":"Selections from Richard Lehman\u2019s Literature Review: July 21st"},"content":{"rendered":"

CardioExchange is pleased to reprint this selection from Dr. Richard Lehman\u2019s\u00a0weekly journal review blog<\/a>\u00a0at\u00a0BMJ.com<\/a>. Selected summaries are relevant to our audience, but we encourage members to engage with the\u00a0entire blog<\/a>.<\/em><\/p>\n

NEJM<\/em> 17 July 2014 Vol 371<\/strong><\/p>\n

Effects of Extended-Release Niacin with Laropiprant in High-Risk Patients (pg. 203):<\/strong> Niacin is an abundant natural B vitamin, which lowers bad cholesterol and raises good cholesterol. What\u2019s not to like? Well, niacin, unfortunately. In doses that\u00a0make any difference to lipid levels, it is very likely to make you feel sick, get flushes and\/or rashes, and\/or feel muscle pains. So Merck decided to market it in combination with laropripant, a prostaglandin antagonist that\u00a0is meant to combat its unpleasant effects. Even so, a third of people who were recruited to the present trial<\/a> could not continue past the run-in phase with the active combination. And now that the full results are out, we have confirmation that this dual agent definitely does not offer any cardioprotection despite its \u201cfavourable\u201d effect on lipids. Worse still it causes bleeding, raises blood sugar, and shows a tendency to increase mortality in those who can tolerate taking it for three years. The Clinical Trials Support Unit (CTSU) at Oxford did a great job of running this trial with funding from Merck, following its usual rules of independence. In doing so, it provides a great illustration of the fact that lipid fractions are very unreliable surrogates for cardiovascular outcomes. But we knew that already, and it seems a great pity to me that many superb researchers were tied down for so long on a project that\u00a0has made such a small contribution to clinical knowledge, whatever it may have contributed to the funds of CTSU.<\/p>\n

Lancet<\/em> 19 July 2014 Vol 384<\/strong><\/p>\n

Dual-Antiplatelet Treatment Beyond 1 Year After DES Implantation (ARCTIC-Interruption) (OL):<\/strong> The arrival of drug-eluting stents signalled a bonanza not just for device manufacturers, but for makers of anti-platelet drugs and platelet testing kits too. The small superiority of the new stents over the old bare metal ones depended on using clopidogrel or a similar agent in addition to aspirin for an initial period, now fixed by tradition at 12 months. An extension of the French ARCTIC-Monitoring trial<\/a> sought to find out whether there might be additional benefit from continuing dual anti-platelet treatment for longer than a year. The answer is no: in fact this just increases the potential for harm from bleeding events.<\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

This week’s topics include the effects of extended-release niacin with laropiprant in high-risk patients and dual-antiplatelet beyond one year after DES implantation.<\/p>\n","protected":false},"author":475,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[821,2314,2313,1613],"class_list":["post-44184","post","type-post","status-publish","format-standard","hentry","category-general","tag-drug-eluting-stents","tag-dual-antiplatelet-treatment","tag-extended-release-niacin","tag-laropiprant"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/44184","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/475"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=44184"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/44184\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=44184"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=44184"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=44184"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}