Indicated to promote the REGRESSION of atherosclerosis
In patients with a history of CAD and hypercholesterolemia, niacin in combination with a bile acid binding resin is indicated to slow progression or promote regression of atherosclerotic disease
Results from the Familial Atherosclerosis Treatment Study (FATS):
Intensive lipid-lowering therapy increased the frequency of regression after 2.5 years of follow-up1,2
Angiographic results obtained from a randomized, double-blind, placebo-controlled trial of 146 men >62 years of age with elevated apolipoprotein B levels, a family history of CAD, and evidence of coronary atherosclerosis. After receiving dietary counseling, patients were randomly assigned to treatment with niacin/colestipol, lovastatin/colestipol, or conventional therapy. Patients were assessed for changes in severity of disease in proximal arteries by quantitative arteriography.
* Conventional therapy consisted of placebos for colestipol/lovastatin, unless the patient's baseline LDL-C level exceeded the 90th percentile for age—those patients received colestipol instead of placebo.
46% of patients taking conventional therapy experienced progression vs 25% of patients taking niacin + colestipol1,2
Results of the Cholesterol-Lowering Atherosclerosis Study (CLAS)2,4
After 2 years, 16.2% of patients receiving niacin 1 g tid + colestipol 15 g bid (n=80) experienced regression of disease vs 2.4% of patients on placebo (n=82; P=0.002)‡1,3
A randomized, placebo-controlled, angiographic trial testing combined colestipol and
niacin therapy in 162 nonsmoking males with previous coronary bypass surgery. The primary cardiac
end point was global coronary artery change score.
Results from the Arterial Biology for the Investigation of the Treatment Effects of Reducing Cholesterol (ARBITER 2)4:
§CIMT = Carotid intima-media thickness.
|| 93.4% (n=156) of the patients were being treated with simvastatin, and the majority 95.8% (n=160) were receiving a daily dose of >20 mg. A randomized, double-blind, placebo-controlled trial of once daily, extended-release niacin (1000 mg) added to background statin therapy in 167 patients with known CHD. The primary end point was the change in common carotid intima-media thickness (CIMT) after 1 year.
- The increase in CIMT in the niacin group was 0.014 mm compared with 0.044 mm in the placebo group (P=0.08)
- Progression rates increased significantly in the placebo group and remained stable in the niacin ER group
- CIMT is a surrogate measurement of coronary atherosclerosis which is noninvasive and uses ultrasound to measure the thickness of the carotid intima media
Next: Reduces Recurrent MI Risk
References
1. NIASPAN® prescribing information. North Chicago, IL; Abbott Laboratories.
2. Brown G, Albers JJ, Fisher LD, et al. Regression of coronary artery disease as a result of intensive lipid-lowering therapy in men with high levels of apolipoprotein B. N Engl J Med. 1990;323:1289-1298.
3. Blankenhorn DH, Nessim A, Johnson RL, Sanmarco ME, Azen SP, Cashin-Hemphill L. Beneficial effects of combined colestipol-niacin therapy on coronary atherosclerosis and coronary venous bypass grafts. JAMA. 1987;257:3233-3240.
4. Taylor AJ, Sullenberger LE, Lee HJ, et al. Arterial Biology for the Investigation of the Treatment Effects of Reducing Cholesterol (ARBITER) 2: a double-blind, placebo-controlled study of extended-release niacin on atherosclerosis progression in secondary prevention patients treated with statins. Circulation. 2004;110:3512-3517.
