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GPs go forth

Adding nicotinic acid to statin cuts atherosclerosis

By Mark Pownall

Patients treated with a statin plus a high dose of nicotinic acid to increase HDL levels have been found to have less atherosclerosis than those treated with statins alone, a new study from the University of Oxford has found.

The study randomised 71 patients to receive either 2g daily modified release nicotinic acid or placebo- plus a statin - and quantified atherosclerosis by measuring areas of plaque in the carotid artery using MRI.

All patients had low levels of HDL - under 1mmol/l - and type 2 diabetes with coronary heart disease or carotid/peripheral atherosclerosis, and who were already taking a statin to lower LDL and total cholesterol.

After a year of treatment nicotinic acid was found to have significantly reduced carotid wall area compared with placebo by –1.64 mm2 .

The atherosclerosis of patients on placebo treatment progressed over 12 months by about the same amount that the atherosclerosis of the niacin treated patients regressed.

Lead researcher Dr Robin Choudhury, clinical director at the University of Oxford Acute Vascular Imaging Centre said: ‘In statin-treated patients with low HDL, high-dose modified-release nicotinic acid, compared with placebo, significantly reduces carotid atherosclerosis within 12 months.'

Journal of the American College of Cardiology 2009 54(19) 1787-94.

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