AHA: Adding Niacin Doesn't Beat Statin Alone for CV Risk

Although addition of niacin increases HDL cholesterol, lowers triglyceride and LDL cholesterol levels

TUESDAY, Nov. 15 (HealthDay News) -- Addition of extended-release niacin to simvastatin offers no additional benefit in reducing cardiovascular risk, according to a study published online Nov. 15 in the New England Journal of Medicine to coincide with its presentation at the American Heart Association's Scientific Sessions 2011, held from Nov. 12 to 16 in Orlando, Fla.

William E. Boden, M.D., from the University at Buffalo in New York, and colleagues examined whether adding extended-release niacin to a simvastatin regimen was better than simvastatin alone at reducing residual cardiovascular risk after attainment of a target low-density lipoprotein (LDL) cholesterol level. Participants were given simvastatin plus ezetimibe, if needed, to maintain the target LDL. Participants were randomized to receive 1,500 to 2,000 mg/day of extended-release niacin (1,718 participants) or placebo (1,696 participants). The first event of the composite of coronary heart disease death, nonfatal myocardial infarction, ischemic stroke, acute coronary syndrome hospitalization, or symptom-driven coronary or cerebral revascularization was the primary end point.

The investigators found a lack of efficacy and discontinued the study after a mean of three years of follow-up. Niacin therapy significantly increased median high-density lipoprotein (HDL) cholesterol (35 to 42 mg/dL) and lowered triglycerides and LDL levels from 164 to 122 mg/dL and from 74 to 62 mg/dL, respectively, at two years. The primary end point was reached in 16.4 and 16.2 percent of the niacin and placebo groups, respectively (P = 0.79).

"We found no incremental benefit of niacin in reducing cardiovascular events over a follow-up period of 36 months, despite significant increases in HDL cholesterol levels and decreases in triglyceride levels," the authors write.

The authors disclosed financial relationships with pharmaceutical comapanies, including Abbott Laboratories, which funded the trial. The study drugs were provided by Abbott (extended-release niacin, placebo, and ezetimibe) and Merck (simvastatin).

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