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AIM-HIGH fails to fly
Despite the efficacy of statins in reducing the risk of cardiovascular disease a substantial number of patients go on to have further events, even when LDL cholesterol targets are achieved. Consequently, interest has grown in combination therapy approaches and the HDL raising treatment niacin—a drug now over 50 years old—has enjoyed something of a renaissance of late in this regard.
In the AIM-HIGH study 3414 patients with known atherosclerotic coronary disease who were already receiving simvastatin (40 to 80 mg) were randomised to 1500 to 2000 mg per day of extended-release niacin (n=1718) or placebo (n=1696). The primary end point was the first event of the composite of death from coronary heart disease, nonfatal myocardial infarction, ischaemic stroke, hospitalisation for an acute coronary syndrome, or symptom-driven coronary or cerebral revascularisation. The trial was stopped early after a follow-up period of 3 years due to a lack of efficacy. Despite niacin significantly increasing median HDL, lowering triglyceride levels and lowering LDL, the primary end point occurred in 282 patients in the niacin …