Nicotinic acid is often given alongside statins in patients with coronary disease to increase levels of HDL cholesterol and further reduce levels of LDL cholesterol, Dr. Robin P. Choudhury, from John Radcliffe Hospital, Oxford, UK, and co-researchers note. The impact of this treatment on atherosclerotic progression, however, was unclear.
To investigate, the researchers assessed the 1-year change in carotid artery wall area, measured by MRI, in 71 patients who were randomized to add modified-release nicotinic acid (2 g daily) or placebo to statin therapy. The subjects all had HDL cholesterol levels below 40 mg/dL and either diabetes with heart disease or carotid/peripheral atherosclerosis.
Nicotinic acid use was associated with a 23% increase in HDL cholesterol and a 19% drop in LDL cholesterol at 12 months, Dr. Choudhury’s team notes.
Relative to placebo, nicotinic acid therapy significantly reduced carotid wall area (adjusted treatment difference: -1.64 millimeters-squared, p = 0.03). In both groups, larger plaques were more likely than smaller ones to change size (p = 0.04 for placebo, p = 0.02 for nicotinic acid).
“The findings support current recommendations for the use of nicotinic acid and strongly underpin the rationale for the large clinical outcome studies that are ongoing,” the authors conclude.
In a related editorial, Dr. Farouc A. Jaffer, from Massachusetts General Hospital, Boston, comments, “These results strengthen the hypothesis that combination niacin plus statin therapy will reduce cardiovascular events compared with statin monotherapy.”
J Am Coll Cardiol 2009;54:1787-1794,1795-1796.