my personal edition > cholesterol/lipid disorders > news


  E-Mail this DGReview to a colleague

DGReview

Statin-Niacin Combination Counters Dyslipidaemic Cardiovascular Risk

Combined statin-niacin is a safe, tolerated therapy that lowers low density lipoprotein cholesterol and raises high density lipoprotein cholesterol.

If treating low density lipoprotein cholesterol is the primary goal, in line with current guidelines, then the ratio of total cholesterol to high density lipoprotein cholesterol is a secondary target that is applicable to more patients than high density lipoprotein cholesterol itself, researchers based at Duke University Medical Center, Durham, North Carolina, United States, report.

The researchers noted that cardiovascular risk might be reduced by targeted changes in both low density and high density lipoprotein cholesterol. That dual strategy, they said, would require a well tolerated, effective regimen as well as a better understanding of how high density lipoprotein cholesterol might be targeted.

The researchers reviewed all patients started on combined statin-niacin therapy at a referral lipid clinic over a 6.5-year period for tolerability, safety and effectiveness in an open-label, uncontrolled study.

More than three quarters (77 percent) of the patients tolerated the statin-niacin therapy. No serious adverse events were attributable to the medication.

In 37 patients who were drug-naive, moderate doses (mean 1180 mg/day) of the combination significantly reduced low density lipoprotein cholesterol (by 31 percent) and significantly increased high density lipoprotein cholesterol (by 29 percent).

At niacin doses of at least 1000 (mean 1480) mg/day added to a constant statin regimen in 29 patients, high density lipoprotein cholesterol rose significantly (by 20 percent). Even at niacin doses below 1000 mg/day (mean 580), received by 23 patients, high density lipoprotein cholesterol rose significantly (by 13 percent).

Although mean high density lipoprotein cholesterol rose, the initial and final high density lipoprotein cholesterol distributions were broad and largely overlapping.

Any chosen cut-off point for high density lipoprotein cholesterol goal would apply to only a minority of patients, the researchers noted. The total/ high density lipoprotein cholesterol ratio had narrower distributions, as the percentage of patients with a ratio below 5.0 increased from 17 percent to 67 percent.
Journal of Cardiovascular Risk 2002;9(6):339-347. "Targeting cardiovascular risk associated with both low density and high density lipoproteins using statin-niacin combination therapy."

E-Mail this DGReview to a colleague

To print, use this version