The use of niacin was associated with a regression of atherosclerotic plaque in a new imaging study.
The recently published study (J Am Coll Cardiol 2009;54:1787-94), was conducted by a group led by Dr Justin Lee (University of Oxford).
In the study, 71 patients with low high-density lipoprotein (HDL) cholesterol and vascular disease were randomised to modified release nicotinic acid (uptitrated to 2 g daily), or placebo. All patients were already taking statins. Magnetic resonance imaging (MRI) was performed at baseline and at six and 12 months, with blood samples taken at the time of MRI.
Results showed that the primary end point of absolute change in carotid artery wall area at one year was reduced by 1.64 mm2 in the niacin group compared to the placebo group, a statistically significant difference. However, there were no significant differences between the two groups in aortic wall area and other measures of vascular function by MRI. Niacin also increased HDL by 23% and decreased low-density lipoprotein (LDL) cholesterol by 19%.
Niacin use has been limited by side effects and these were again problematic in this study, with 20% of the niacin group withdrawing because of drug-related side effects (flushing, itching, and gastrointestinal upset) or MRI claustrophobia.
The researchers conclude: “Our study shows, for the first time, that in patients with low HDL-C and existing atherosclerotic disease, addition of nicotinic acid 2 g daily to contemporary therapy reduces atherosclerosis compared with placebo. The findings support current recommendations for the use of nicotinic acid and strongly underpin the rationale for the large clinical outcome studies that are ongoing”.