The ARBITER 6-HALTS Trial: Clinical Implications

Previous trials, including the ENHANCE trial, have raised doubts about the clinical benefits of adding ezetimibe to high-dose statin therapy. The ARBITER 6-HALTS trial added further weight to the results of ENHANCE, wherein the ARBITER trial demonstrated that extended-release niacin was superior to ezetimibe as adjunctive therapy to high-dose statins in slowing atherosclerosis. However, this study was not based on clinical outcomes, but rather on measuring carotid intima-media thickness (CIMT). In addition, the ARBITER trial was relatively small, based on 208 patients completing the trial. Are these data enough to impact clinical use of ezetimibe and niacin, or should we await results of further large-scale trials? Dr. Christopher Cannon, associate professor of medicine at Harvard Medical School and editor-in-chief of the American College of Cardiology's Cardiosource, weighs in on these questions and more regarding adjunctive therapy to high-dose statins, with host Dr. Jack Lewin.