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MRI-measured regression of carotid atherosclerosis induced by statins with and without niacin in a randomised controlled trial: the NIA plaque study
  1. Christopher T Sibley1,2,
  2. Andrea L Vavere2,
  3. Ilan Gottlieb2,
  4. Christopher Cox3,
  5. Matthew Matheson3,
  6. Amy Spooner2,
  7. Gustavo Godoy2,
  8. Veronica Fernandes2,
  9. Bruce A Wasserman4,
  10. David A Bluemke1,4,
  11. Joao A C Lima2,4
  1. 1Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Maryland, USA
  2. 2Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
  3. 3Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  4. 4Department of Radiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
  1. Correspondence to Dr Joao A C Lima, Department of Medicine, Division of Cardiology, The Johns Hopkins Hospital, 600 N. Wolfe Street, Blalock 524, Baltimore, MD 21287, USA; jlima{at}jhmi.edu

Abstract

Objective To evaluate the benefit of niacin in addition to statin therapy on plaque regression among older individuals with established atherosclerosis.

Design Randomised, controlled, double-blind clinical trial.

Setting University outpatient center.

Patients 145 patients older than 65 years, half of them older than 75 years of age, with established atherosclerosis were enrolled.

Interventions Participants received either extended release niacin (1500 mg daily) or placebo in addition to statin therapy to reach their National Cholesterol Education Program-defined low density lipoprotein (LDL) cholesterol target.

Main Outcome Measures The primary endpoint was reduction in the wall volume of the internal carotid artery (ICA) measured by MRI.

Results After 18 months, high density lipoprotein cholesterol was higher with statins plus niacin compared with statins alone (1.6±0.4 vs 1.4±0.4 mmol/L p<0.001). Both groups had significant decreases in the main outcome measure of ICA wall volume, which regressed at 0.5%/month (SEM 0.2, p=0.004) in the statins plus placebo group and at 0.7%/month in the statins plus niacin group (SEM 0.2, p<0.001). There was no difference in the rate of regression between groups (p=0.49).

Conclusions Treatment with statin therapy to presently recommended LDL levels, with or without niacin, resulted in significant atherosclerosis reduction.

  • Lipids
  • Coronary Artery Disease

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