Two-Pronged Cholesterol Approach Lowers Heart Risk

Researchers say that adding another medication to cholesterol-lowering statins is more effective at slowing the progression of heart disease than the traditional treatment of just using statins alone.

A study has found that raising HDL ("good") cholesterol by adding extended-release niacin to a drug regimen of statins, which lower LDL ("bad") cholesterol, slowed the progression of atherosclerosis, the dangerous buildup of plaque in the arteries.

These findings may signal a shift in the focus of current treatment.

The Study

This study, conducted by Walter Reed Medical Center researchers, looked at 149 people who had known coronary heart disease (some had had heart attacks) and low levels of HDL All had been on a statin for approximately 4.5 years.

Patients were randomized to receive either Niaspan, an extended-release prescription niacin, or a placebo. The study was partially funded by Kos Pharmaceuticals, which makes the drug.

The purpose of the study was to find out whether adding niacin to the statin treatment had any effect on hardening of the carotid artery. It is the first study to look at such a combination therapy.

After one year, HDL cholesterol increased 21% in patients taking niacin, and there was no change in the plaque buildup in the carotid artery. The plaque buildup increased significantly in patients getting the placebo.

Overall, combining niacin with a statin slowed disease progression 68% more than using a statin alone. The combination treatment also resulted in a 60% reduction in heart attacks, deaths, strokes and other coronary events, the researchers report.

The Reaction

"This is a combination which is very encouraging... We're beginning to gather evidence that making HDL levels higher will, in fact, either arrest development (or maybe even reverse some of the atherosclerosis that's already there," says Dr. John C. LaRosa, president of the State University of New York Downstate Medical Center.

"Most of the LDL-lowering trials still leave from two-thirds to one-half of patients going on to get another event, so it's not enough by itself," he notes.

"This study gives us scientific evidence to document that if you add Niaspan to an aggressive, good LDL-lowering program, it actually does make a difference," says Dr. Stephen Siegel, a clinical assistant professor of medicine at New York University School of Medicine. "The trouble with the study is that it's such a small number of people."

Niacin is the most effective way to treat low HDL. One drawback of niacin is that it causes redness on the face and upper body, and many patients find this side effect difficult to tolerate. But because Niaspan is a slow-release drug, it causes less flushing than other forms of niacin. Taking it at bedtime-along with aspirin and a low-fat snack-has been found to help further reduce flushing.