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Adding niacin better than doubling simvastatin dose

Adding extended-release niacin to simvastatin improves lipid profiles more effectively than doubling the dose of simvastatin, say US researchers.

They analysed data from 343 patients with mixed dyslipidaemia being inadequately treated with 40mg simvastatin and randomised them to receive 80mg of the statin or 40mg plus 1000mg or 200mg niacin.

Levels of HDL-cholesterol, triglycerides and apolipoprotein-a did not change in patients on the 80mg simvastatin dose but HDL-cholesterol rose by 22% in those taking niacin 2,000mg and triglycerides and lipoprotein-a fell by 32% and 21% respectively.

Flushing is a major treatment-limiting side effect of niacin. Five per cent of niacin-treated patients in this trial withdrew due to intolerable flushing. However, about half of the patients who complained of flushing during the first 12 weeks of the study did not report further episodes during the second 12 weeks.

J Clin Lipidol 2008; 24 February early online publication

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