An interesting study just released in the NEJM  suggests that the old standby niacin (called Niaspan in its extended release form) is superior in reducing carotid plaque buildup than the more expensive ezetimibe (Zetia) when combined with a statin.

Although the study sample was small (208) participants, the study was halted early b/c results showed that the niacin/statin group had significant regression of plaque with the study authors, Allen J. Taylor, M.D. et al, concluding that “…niacin is superior to ezetimibe.” 

The study included patients who had:

• coronary heart disease or were at high risk for it
• had been on long term statin therapy
• had LDL (bad cholesterol) levels under 100 mg/dL
• had HDL  (good cholesterol) levels under 50 mg/dL in men and 55 mg/dL in women.

 The overall goal is to reduce cardiovascular risk and statins have been at the forefront of therapy reducing adverse clinical events by 30% to 40%. Despite the success of statins, many patients have not achieved reduced LDL levels or they have suffered a heart attack or stroke.

Options have been to add another medication that either reduces LDL levels by blocking the absorption of cholesterol (Zetia) or add medication that increases the good cholesterol levels (HDL) using extended release niacin (Niaspan).

Since the study was so small, no one is recommending that Zetia be stopped or that everyone should be on Niaspan but the results do suggest that raising HDL in addition to lowering LDL levels may be more beneficial than simply lowering LDL levels. 

Given the importance of these findings, the results from two other larger studies currently underway (AIM-HIGH and HPS2-THRIVE) will help determine which drug combination decreases the risk of heart attacks and strokes.