National Lipid Association: AIM-HIGH Results “Disappointing” But Prescribing Practices Should Not Change 1

The National Lipid Association has issued a statement to its members about the AIM-HIGH Study. The NLA acknowledges that the “findings are disappointing since clinicians have used extended-release niacin to treat patients with low HDL-C” but urges its members to “await full availability and review of the trial before integrating this information into clinical practice.”

The statement recommends that

physicians should not alter their prescribing practices at this time if that would deter patients from achieving NCEP targets. A continued focus on achieving risk stratified NCEP goals and recommending diet changes and especially exercise regimens is warranted for managing cardiovascular disease in patients with known risk and low HDL levels.

For patients, the NLA says that

discontinuing therapy is the wrong action and should not be done without the advice of your physician…. Furthermore, the findings presented should be interpreted with caution until the full study details are available and additional studies are completed that should provide insight into the effect of niacin in other populations.

Full Disclosure?

At the end of the statement the NLA discloses that it

has received educational grants from multiple manufacturers to support accredited medical educational activities. There was no funding or any interaction with any manufacturer in regard to this statement.

The statement also includes financial disclosures in a pop-up window for each of the 12 authors:

The NLA contributors to this paper have provided full disclosures and their thoughts on this matter have not been influenced by bias or commercial interest.

All the authors disclosed multiple relationships with industry, and nearly all had relationships with Abbott and/or Merck, the two largest marketers of prescription niacin products.

See previous CardioBrief articles about the relationship of the NLA with industry here, here, and here.

Comment: To be very clear: the NLA receives extensive industry support, and each and every author of this statement has multiple financial ties to industry, and nearly all have financial relationships with companies that make niacin products. To then claim that the statement has “not been influenced by bias or commercial interest” is simply absurd. Imagine for a second that AIM-HIGH had turned up a highly positive result for niacin. Do you think the NLA would have been as conservative and cautious in its interpretation and recommendations about those results?

Let me also be clear that I believe that reasonable people might accept the substance of the NLA statement. The problem is that it claims to represent an independent scientific or medical consensus of opinion, when in fact it represents the interests of industry itself or of those who rely on industry for a significant portion of their funding. It’s a significant distinction worth remembering.

Finally, the peek-a-boo pop-up windows of the authors disclosures are a perfect example of the really cheesy and cynical efforts of industry to foil the spirit and substance behind conflict of interest disclosures. (Much like the use of the extremely user-unfriendly PDFs that industry has released in disclosing payments to physicians.)

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One comment

  1. I am a patient and policy prof who turned down niaspan because there was no scientific evidence of benefit relative to risk, which is not trivial.

    There still isn’t, unless having more sexy numbers is considered a benefit.

    The original Abbott was more clear about it: “‘I don’t know’s’ on third.”

    Now we know more than we did, but apparently that is supposed not to affect how we play ball.

    Someone explain to me why this isn’t crazy.

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