Document Detail

Effects of high-dose modified-release nicotinic acid on atherosclerosis and vascular function: a randomized, placebo-controlled, magnetic resonance imaging study.
MedLine Citation:
PMID:  19874992     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: Our aim was to determine the effects of high-dose (2 g) nicotinic acid (NA) on progression of atherosclerosis and measures of vascular function.
BACKGROUND: NA raises high-density lipoprotein cholesterol (HDL-C) and reduces low-density lipoprotein cholesterol and is widely used as an adjunct to statin therapy in patients with coronary artery disease. Although changes in plasma lipoproteins suggest potential benefit, there is limited evidence of the effects of NA on disease progression when added to contemporary statin treatment.
METHODS: We performed a double-blind, randomized, placebo-controlled study of 2 g daily modified-release NA added to statin therapy in 71 patients with low HDL-C (<40 mg/dl) and either: 1) type 2 diabetes with coronary heart disease; or 2) carotid/peripheral atherosclerosis. The primary end point was the change in carotid artery wall area, quantified by magnetic resonance imaging, after 1 year.
RESULTS: NA increased HDL-C by 23% and decreased low-density lipoprotein cholesterol by 19%. At 12 months, NA significantly reduced carotid wall area compared with placebo (adjusted treatment difference: -1.64 mm(2) [95% confidence interval: -3.12 to -0.16]; p = 0.03). Mean change in carotid wall area was -1.1 +/- 2.6 mm(2) for NA versus +1.2 +/- 3.0 mm(2) for placebo. In both the treatment and placebo groups, larger plaques were more prone to changes in size (r = 0.4, p = 0.04 for placebo, and r = -0.5, p = 0.02 for NA).
CONCLUSIONS: In statin-treated patients with low HDL-C, high-dose modified-release NA, compared with placebo, significantly reduces carotid atherosclerosis within 12 months. (Oxford Niaspan Study: Effects of Niaspan on Atherosclerosis and Endothelial Function; NCT00232531).
Justin M S Lee; Matthew D Robson; Ly-Mee Yu; Cheerag C Shirodaria; Colin Cunnington; Ilias Kylintireas; Janet E Digby; Thomas Bannister; Ashok Handa; Frank Wiesmann; Paul N Durrington; Keith M Channon; Stefan Neubauer; Robin P Choudhury
Publication Detail:
Type:  Comment; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  54     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2009 Nov 
Date Detail:
Created Date:  2009-10-30     Completed Date:  2009-11-12     Revised Date:  2011-10-24    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1787-94     Citation Subset:  AIM; IM    
Department of Cardiovascular Medicine, University of Oxford and Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Oxford, United Kingdom.
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MeSH Terms
Carotid Artery Diseases / drug therapy*,  pathology,  physiopathology*
Cholesterol, HDL / blood,  drug effects
Cholesterol, LDL / blood,  drug effects
Confounding Factors (Epidemiology)
Delayed-Action Preparations
Double-Blind Method
Drug Administration Schedule
Hypolipidemic Agents / administration & dosage,  pharmacology,  therapeutic use*
Magnetic Resonance Imaging*
Middle Aged
Niacin / administration & dosage,  pharmacology,  therapeutic use*
Time Factors
Treatment Outcome
Triglycerides / blood
Tunica Intima / drug effects,  pathology,  physiopathology
Tunica Media / drug effects,  pathology,  physiopathology
Grant Support
//Wellcome Trust
Reg. No./Substance:
0/Cholesterol, HDL; 0/Cholesterol, LDL; 0/Delayed-Action Preparations; 0/Hypolipidemic Agents; 0/Triglycerides; 59-67-6/Niacin
Comment On:
J Am Coll Cardiol. 2009 Nov 3;54(19):1795-6   [PMID:  19874993 ]

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