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About 5% of Long-Term Niacin Users Evolve Into HDL Hyperresponders: Presented at ACC
By Ed Susman
ATLANTA, G.A. -- March 14, 2006 -- An institutional review of patients on niacin therapy to reduce cholesterol and raise high-density lipoprotein (HDL) cholesterol found that about 5% of patients on long-term therapy become hyperresponders, increasing their HDL levels by 50% or more.
In investigating "HDL creep" -- a phenomenon noted in studies of extended release niacin combined with a statin (niacin/lovastatin-Advicor) -- Leonard Keilson, MD, director, Maine Center for Lipids and Cardiovascular Health, Scarborough, Maine, identified 13 hyperresponders from among 270 patients on long-term therapy in his practice.
In the Advicor 12-month trial, patients on the drug increased HDL cholesterol by 30% at 16 weeks and 41% at 52 weeks.
"In addition to this HDL creep in our hyperresponders, we also found that these patients experienced reductions in body weight and a reduction in triglycerides," he said in a poster presentation on March 11th at the 55th Annual Scientific Session of the American College of Cardiology (ACC).
"Long-term effects of niacin treatment may occur even beyond the cessation of therapy," he said, noting that The Coronary Drug Project utilized 5 years of niacin therapy as an intervention and beneficial effects were noted at least 9 years beyond the termination of the trial.
To examine the phenomenon more closely, Dr. Keilson reviewed records of 270 patients at the Maine Center for Lipids. Those patients have been on niacin therapy for as long as 10 years, He said.
Dr. Keilson identified 13 patients among the 270 -- about 4.8% of the group -- that achieved greater than a 50% increase in HDL since initiating niacin therapy. Therapy ranged from 3 years to 10 years for the hyperresponders.
These patients made an average of 22 office visits over a 7-year period. At the beginning of treatment, the average patient had an HDL level of 32.2 mg/dL and triglycerides of 288 mg/dL.
When Dr. Keilson analyzed the responses, he found that the HDL levels increased 90% overall, with some outstanding examples, such as 1 patient who increased HDL from a baseline level of 15 mg/dL to 39 mg/dL 10 years later. For all 13 of these patients, the HDL increases ranged from 52% to 153%. The average triglyceride levels fell 43% from baseline, he said.
About 69% of the patients were treated with statins during the entire treatment period; all were treated with statins for at least 2 years while on concurrent niacin therapy.
Overall, these patients lost 4% of body weight while on niacin treatment, Dr. Keilson said.
[Presentation title: Profound Increase of High-Density Lipoprotein-Cholesterol Levels (>50%) With Long-Term Niacin Treatment. Abstract 914-204]
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