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Physicians: .25 AMA PRA Category I CreditsTM
To Receive Credit
In order to receive your certificate of participation, you should read the information about this activity, including the disclosure statements, review the entire activity, take the post-test, and complete the evaluation form. You may then follow the directions to print your certificate of participation. To begin, click the CME icon above.
Upon successful completion of this educational program, the reader should be able to:
Alan Ehrlich, MD
Dr. Ehrlich, Dr. Fleming, DynaMed Editorial Team members, and the staff of Antidote Education Company have disclosed that they have no relevant financial relationships or conflicts of interest with commercial interests related directly or indirectly to this educational activity.
ACCME: This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Antidote Education Company and EBSCO Publishing. Antidote is accredited by the ACCME to provide continuing medical education for physicians. Antidote Education Company designates this enduring activity for a maximum of 0.25 AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.
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Last week 793 journal articles were evaluated via DynaMed's Systematic Literature Surveillance and summaries of 181 articles were added to DynaMed content.
Addition of Extended-Release Niacin/Laropiprant to Statin-Based Therapy Increases Risk of Serious Adverse Events and Does Not Decrease Risk of Major Vascular Events in Patients With Vascular Disease
For several decades, observational studies have shown correlations between certain lipid markers and risk of major vascular events. Several of these markers have been evaluated as potential targets for the prevention or management of vascular disease. Niacin (also called nicotinic acid or vitamin B3) is an essential human nutrient that increases high density lipoprotein (HDL) cholesterol concentrations through several different mechanisms. Improvements in clinical outcomes in patients at risk of cardiovascular disease have been demonstrated with reduction in low density lipoprotein (LDL) cholesterol concentration. However, although increased HDL cholesterol concentrations are correlated with lower risk of vascular events in observational studies, it has remained unclear whether the addition of niacin to statin-based therapy actually helps decrease the risk of major vascular events. A recent large randomized trial evaluated the addition of a combination of niacin and laropiprant (a prostaglandin inhibitor used to prevent flushing) in patients with vascular disease receiving statin-based therapy.
The findings from this new trial are also consistent with those of the AIM-HIGH trial, which also found no reduction in vascular events with extended-release niacin compared to placebo in patients receiving statin therapy (N Engl J Med 2011 Dec 15;365(24):2255). Furthermore, this new trial showed that the use of combination niacin/laropiprant increases the rate of adverse events. In addition, the adverse event rate observed in this trial underestimates the true adverse event rate associated with treatment, since patients experiencing adverse events during the unblinded run-in period were excluded from the trial. It is noteworthy that many adverse events observed in the new trial, including infection and gastrointestinal bleeding, were not expected based on previous studies evaluating niacin such as AIM-HIGH, and may be associated with laropiprant as opposed to niacin itself. As well, it is noteworthy that in this trial, although niacin/laripoprant was associated with substantially increased HDL cholesterol concentrations, the baseline HDL cholesterol levels were not substantially below the normal threshold (about 44 mg/dL in each group). Thus the interpretation of these findings is less clear for patients with low or very low HDL cholesterol levels – the population towards which niacin treatment is primarily targeted.
EBSCO Health Launches Pediatric Clinical Information Mobile App
PEMSoft Now Available For iPhone, iPad, and Android Devices
A mobile app designed specifically for pediatricians, emergency department physicians, physicians-in-training and other medical providers caring for children with acute illnesses and injury, is now available from EBSCO Health, the leading provider of clinical decision support solutions for the healthcare industry.
Call for Peer Reviews
We are currently seeking subspecialty reviewers for our Patient Education Resource Center (PERC). PERC provides fact sheets and discharge instructions for patients leaving the hospital or emergency room. These hand-outs fulfill the meaningful use requirements for the Medicare & Medicare Services Incentive Programs.
DynaMed Contribution Opportunities