Statin therapy is a mainstay of treatment in patients with high levels of low-density lipoprotein (LDL) cholesterol and reduces the risk of cardiac events by about 30%. Niacin has been shown to be one of the most effective drugs for improving levels of high-density lipoprotein (HDL) cholesterol, or good cholesterol.

"Combining the best LDL lowering and best HDL raising drugs makes sense," said lead author Jason Logan, MD, Family Physician, In His Image Family Practice Residency, Tulsa, Oklahoma, United States.

In the prospective, open label, single-intervention trial, the researchers compared lipid profiles of 67 participants receiving combination treatment against baseline measurements and against results from a similarly designed study using atorvastatin (Calcium Antagonist Reinfarction Italian Study).

The 67 patients received 500 mg of extended-release niacin and 20 mg of lovastatin to start and were titrated up to 1000 mg of niacin. All participants were receiving standard care but were not meeting LDL goals as set by the National Heart, Lung and Blood Institute's cholesterol guidelines.

Of the 61 patients who completed the study, 20 were on statin monotherapy and 41 were on therapeutic lifestyle modification alone at baseline.

In the group previously on statin alone, 75% of patients achieved LDL cholesterol goals on combination therapy. LDL decreased by 33.4% on average and HDL increased by 18.9%. Triglycerides decreased by 30.2%.

Those who had not taken statins prior to the study had an even higher risk reduction (62.9% versus 59.7%). A clinically significant 90.2% of patients met the LDL goal with an average decrease of 43.8%. Triglycerides improved by 41.8% and HDL increased by 15.4%.

Comparing this to the atorvastatin study results, the coronary artery disease risk reduction with combination therapy was superior to atorvastatin alone (65.7% compared to 38.8%).

One patient withdrew from the study due to flushing related to niacin therapy; 16% of patients reported flushing, which improved over time, Dr. Logan said.

"Combination therapy with niacin extended-release and lovastatin is underused," he added, "but may be the most effective treatment for substantially correcting both of these lipoprotein abnormalities and drastically reducing coronary artery disease risk."


[Presentation title: Extended-Release Niacin/Lovastatin Versus Usual Care for Treatment of Dyslipidemia in a Primary Care Setting ("EXTEND" Study). Family Medicine Research Presentations]

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