Combined Nicotinic Acid and Statin Treatment Reduces Atherosclerosis

A recent study showed that combining statin treatment to lower cholesterol levels with nicotinic acid (niacin) to raise the level of HDL (high density lipoprotein) cholesterol improved the condition of patients with established cardiovascular disease.

Investigators at Oxford University (United Kingdom) performed a double-blind, randomized, placebo-controlled study of two grams of daily modified-release nicotinic acid added to statin therapy in 71 patients with low HDL cholesterol (less than 40 mg/dl) and either type II diabetes with coronary heart disease; or carotid/peripheral atherosclerosis. The primary end point of the study was the determination after one year of the change in carotid artery wall area, quantified by MRI (magnetic resonance imaging).

The investigators reported in the November 3, 2009, issue of the Journal of the American College of Cardiology that the statin-nicotinic acid regimen increased HDL cholesterol by 23% and decreased LDL (low density lipoprotein) cholesterol by 19%. At 12 months, the carotid wall area was significantly reduced compared with placebo (decreased by an average of 1.1 mm2 for those on the drug combination as opposed to an average increase in the carotid artery wall of 1.2 mm2 for those receiving a placebo).

"This is the first clear evidence that a therapy to raise levels of good cholesterol (HDL) when taken alongside statins can have a beneficial effect," said senior author Dr Robin Choudhury, professor of cardiovascular medicine at the University of Oxford. "Using MRI scans, we have shown a reduction in the size of artery walls in patients after a year of treatment with nicotinic acid. Our imaging study has identified this as a very promising new prospect for treatment, and if the findings are borne out in ongoing larger studies this could benefit large numbers of people worldwide."

"Our results are very encouraging in that they have shown a very definite potential benefit, and will certainly increase the great interest in the large outcome studies that are due to report in the next couple of years," said Dr. Choudhury. 'For years we had always been taught that atherosclerosis was a relentless progressive disease. It is exciting to see a regression in established atherosclerosis."


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