The following is an excerpt from the Summer 2011 issue of, “The Weatherhead P.E.T. Imaging Center for Preventing and Reversing Atherosclerosis’s” newsletter called, “P.E.T. News”.
New study about HDL cholesterol Treatment
The National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health has stopped
a clinical trial studying a blood lipid treatment 18 months earlier than planned. The trial found that adding high
dose, extended-release niacin to statin treatment in people with heart and vascular disease did not reduce
the risk of cardiovascular events, including heart attacks and stroke. This report has prompted lots of calls from patients wondering whether they should continue taking Niaspan.
Before taking any action based on this study alone, we always take a careful look at how the study was conducted and how it compares to other studies looking at the same issue. The results of this study are CONTRARY to several other large randomized trials that show a substantial benefit from raising HDL cholesterol. The data on the recent Niaspan trial has not been published in the medical journals yet so that it cannot be adequately evaluated.
However, several points stand out as follows:
1. The study showed no harm, but was stopped due to a reported lack of benefit without specific data provided
until this fall.
2. The patients selected had weighted average baseline LDL of 74 and HDL of 34. The HDL increased by 20%
to approximately 41 with Niaspan. Thus, the baseline lipids were not as severe as we commonly see in patients
with higher LDL, higher triglycerides and lower HDL. The study failed to achieve our HDL target of 45 to
50mg/dl and also failed to achieve the lipid and weight goals of our program.
3. The randomized, well done, definitive FATS and HATS trials of triple therapy including niacin showed
an 80% to 90% decrease in coronary events, the greatest benefit of any treatment ever reported for coronary artery disease and nearly double the benefit from statins alone.
4. Niaspan also changes the LDL and HDL particle size to the larger fluffier cholesterol particles such that
the larger LDL particles are less atherogenic and the larger HDL particle size provides more effective reverse
cholesterol transport out of atheroma thereby lowering atheromatous risk.
5. No drug therapy is a substitute for healthy food, lean body weight and exercise. The healthy living combined
with drug treatment to correct all lipid abnormalities is more effective than either approach alone, as shown in
the randomized HATS and FATS trial as well as the nonrandomized trial at the University of Texas.
We are not advising our patient to stop Niaspan as a result of these news reports. A large body of scientific data
indicates that Niapsan combined with other medications is beneficial, not contravened by the recent news reports.
Combined medications and healthy living as outlined above provide the best outcomes as we emphasize in our
program. Further analysis of the study will be conducted when it is available.
Read the full issue of P.E.T. News by clicking the following link. PET News Summer 2011