What is the efficacy of combined niacin/statin for the treatment of low HDL cholesterol (hypoalphalipoproteinemia)?

Updated: May 21, 2021
  • Author: Vibhuti N Singh, MD, MPH, FACC, FSCAI; Chief Editor: George T Griffing, MD  more...
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A niacin/statin combination was also evaluated in the HDL-Atherosclerosis Treatment Study (HATS). [40] In this investigation, LDL levels fell by 42% (P< 0.001) and HDL levels increased by 26% (P< 0.001). Angiographic analysis revealed that the combination therapy significantly enhanced stenosis regression. The statin/niacin combination also resulted in a 60-90% reduction in the incidence of major coronary events.

ARBITER 2 study

In the ARterial Biology for the Investigation of the Treatment Effects of Reducing Cholesterol (ARBITER 2) study, a double-blind, placebo-controlled trial was performed on an extended-release niacin/statin therapy. [41] One group of patients received the combination therapy, while another group received only statin. HDL levels in the combination group rose 21% higher (P = 0.002) than they did in the statin-only group, and TGs decreased significantly (P = 0.009). The primary endpoint of ARBITER 2 was change in common carotid intima-media thickness (CIMT). CIMT progression was 68% lower in the niacin/statin group than in the other patients. The end result was a 50% reduction in the composite cardiovascular endpoint for the niacin/statin patients.

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