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  1. Alistair Lindsay, Editor

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General Cardiology

Niacin HALTS progression of carotid thickness in imaging trial

As a result of the residual risk that remains with statin monotherapy, cholesterol treatment can be intensified with the use of a secondary agent such ezetimibe or nicotinic acid. Whereas ezetimibe has potent low-density lipoprotein (LDL)-lowering capabilities, nicotinic acid is also capable of raising high-density lipoprotein (HDL)-cholesterol and lowering triglyceride levels.

The Arterial Biology for the Investigation of the Treatment Effects of Reducing Cholesterol 6—HDL and LDL treatment strategies (ARBITER6—HALTS) trial compared the effects of either niacin or ezetimibe added to long-term statin therapy on carotid intima media thickness (CIMT). Patients either with or at risk of coronary heart disease with LDL-cholesterol levels less than 2.6 mmol/l and HDL cholesterol levels less than 1.4 mmol/l were randomly assigned to receive either extended-release niacin (target dose of 2000 mg/day) or ezetimibe (10 mg/day). The primary endpoint was the between-group difference in the change from baseline in the mean common CIMT after 14 months. In addition to raising HDL, niacin was noted to reduce LDL and tryglyceride levels significantly; however, ezetimibe led to greater LDL lowering. When compared with ezetimibe, nicotinic acid therapy led to a greater efficacy regarding the change in mean CIMT over 14 months (p=0.003).

Conclusions

In this comparative-effectiveness trial, extended-release niacin (when combined with statin therapy) led to a significant regression of CIMT when compared with the use of ezetimibe with a statin. However, the population studied already had low levels of LDL-cholesterol, which would minimise any potential benefit from …

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