No extra benefit by adding niacin to statin if LDL less than 70

No extra benefit by adding niacin to statin if LDL less than 70

No extra benefit by adding niacin to statin if LDL less than 70: The AIM-HIGH Investigators William E Boden, Jeffrey L Probstfield, Todd Anderson, Bernard R Chaitman, Patrice Desvignes-Nickens, Kent Koprowicz, Ruth McBride, Koon Teo and William Weintraub [1] evaluated whether adding niacin to simvastatin for raising HDL cholesterol is better than simvastatin alone, after achieving target LDL levels. All their patients were on simvastatin 40 – 80 mg plus ezetimibe 10 mg if needed, to maintain LDL cholesterol level of 40 – 80 mg per deciliter. There were above three thousand and four hundred patients in the trial and the follow up period was three years at which it was stopped due to lack of efficacy. Primary endpoint was the initial event of a composite of death from coronary artery disease, nonfatal myocardial infarction, ischemic stroke, hospitalization for acute coronary syndrome or symptom driven coronary or cerebral revascularization. Two years of treatment with niacin increased HDL cholesterol from 35 mg/dl to 42 mg/dl and decreased triglyceride from 164 mg/dl to 122 mg/dl. There was also a decrease in LDL from 74 mg/dl to 62 mg/dl. The primary endpoint occurred in 282 patients in the niacin group and 274 patients which was not statistically significant (P=0.79).

The authors concluded that in patients with atherosclerotic cardiovascular disease and LDL cholesterol levels below 70 mg/dl, there was no added benefit by giving niacin along simvastatin.

Reference

1. AIM-HIGH Investigators; William E Boden, Jeffrey L Probstfield, Todd Anderson, Bernard R Chaitman, Patrice Desvignes-Nickens, Kent Koprowicz, Ruth McBride, Koon Teo, William Weintraub. Niacin in Patients With Low HDL Cholesterol Levels Receiving Intensive Statin Therapy. N Engl J Med. 2011 Dec 15;365(24):2255-67.