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Niacin Extended-Release Lovastatin Effective In Lowering Cholesterol

Daily niacin combined with extended-release lovastatin appears to be superior to standard doses of atorvastatin or simvastatin for cholesterol modulation.

This finding was the result of A comparison of once daily, niacin extended-release (ER) lovastatin with standard doses of atorvastatin and simvastatin in the advicor versus other cholesterol-modulating agents trial evaluation [ADVOCATE]), assessed by Dr B E Bays and colleagues at the Louisville Metabolic and Atherosclerosis Research Center, Kentucky, United States.

The cohort was made up of 315 patients with elevated low- density lipoprotein (LDL) cholesterol and decreased high- density lipoprotein (HDL) cholesterol blood levels. These levels were defined as LDL cholesterol blood levels >/=160 mg/dL without coronary artery disease, or >/=130 mg/dL if coronary artery disease was present, and HDL cholesterol <45 mg/dL in men, and <50 mg/dL in women.

The patients were randomised to receive either atorvastatin, simvastatin, or niacin ER/lovastatin for 16 weeks. Primary efficacy variables were defined as the mean percent change in LDL cholesterol and HDL cholesterol levels from baseline.

The researchers found that after eight weeks, the starting doses of niacin ER/lovastatin 1,000/40 mg, and 10- mg dose atorvastatin both lowered mean LDL cholesterol by 38%. After 12 weeks, niacin ER/lovastatin 1,000/40 mg lowered LDL cholesterol by 42%, compared with 34% from the 20-mg starting dose of simvastatin.

Niacin ER/lovastatin increased HDL cholesterol significantly more than atorvastatin or simvastatin at all the comparative doses. It also produced significant improvements in triglycerides, lipoprotein(a), apolipoprotein A-1, apolipoprotein B, and HDL sub- fractions.

Flushing was a problem among 6% of the patients taking niacin ER/lovastatin and they withdrew from the study. There were no significant differences between the three groups for leaving the study because of elevated liver enzymes. The clinicians did not observe any drug-induced myopathy.

Dr Bays and colleagues conclude: "Niacin ER/lovastatin was comparable to atorvastatin 10 mg and more effective than simvastatin 20 mg in reducing LDL cholesterol, was more effective in increasing HDL cholesterol than either atorvastatin or simvastatin, and provided greater global improvements in non-HDL cholesterol, triglycerides, and lipoprotein(a)."
Am J Cardiol 2003;91:6:667-72.

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