Abstract
The metabolic syndrome includes both dyslipidemia and impaired vascular function. Because extended-release niacin (ERN) and prescription omega-3 acid ethyl-esters (P-OM3) independently improve these characteristics, we tested their effects in combination. Sixty metabolic syndrome subjects were randomized to 16 weeks of treatment on dual placebo, P-OM3 (4g/day), ERN (2 g/day), or combination in a double-blind trial. Lipoprotein subfractions and vascular endpoints were measured and tested using ANCOVA. ERN increased HDL cholesterol by 5.4 mg/dl from baseline (P = 0.04), decreased triglycerides (TG) by 39 mg/dl (−21%, P = 0.003), and decreased the augmentation index, which is a measure of vascular stiffness, by 3.5 units (P = 0.04). P-OM3 reduced TG by 26 mg/dl (−13%, P = 0.04). Combination treatment increased HDL cholesterol by 7.8 mg/dl (P = 002) and decreased TG by 72 mg/dl (−34%) but there was no improvement in vascular stiffness. Detailed analysis of lipoprotein subfractions revealed increased large, bouyant HDL2 (3.3 mg/dl; P = 0.002) and decreased VLDL1+2 (−32%; P < 0.0001), among subjects treated with combination therapy, that were not present with either therapy alone. ERN and P-OM3 alone improved characteristics of metabolic syndrome; however, whereas subjects on combination therapy did not have improved vascular stiffness, TG and HDL levels improved as did certain lipoprotein subfractions.
Highlights
The metabolic syndrome includes both dyslipidemia and impaired vascular function
Metabolic syndrome is defined by central obesity, elevated triglyceride (TG) levels, decreased HDL cholesterol (HDL-C) levels, and mild elevations of glucose and blood pressure; numerous physiologic dysfunctions contribute to the overall pathology
At the completion of the study, the majority (38; 63%) of subjects guessed they were taking extended-release niacin (ERN) and 22 (37%) guessed they were on active prescription omega-3 acid ethyl-esters (P-OM3) treatment, but there was no difference between the guesses of subjects in the placebo or treatment groups (Fisher P = 0.43)
Summary
The metabolic syndrome includes both dyslipidemia and impaired vascular function. Because extended-release niacin (ERN) and prescription omega-3 acid ethyl-esters (P-OM3) independently improve these characteristics, we tested their effects in combination. ERN increased HDL cholesterol by 5.4 mg/dl from baseline (P = 0.04), decreased triglycerides (TG) by 39 mg/dl (؊21%, P = 0.003), and decreased the augmentation index, which is a measure of vascular stiffness, by 3.5 units (P = 0.04). Combination treatment increased HDL cholesterol by 7.8 mg/dl (P = 002) and decreased TG by 72 mg/dl (؊34%) but there was no improvement in vascular stiffness. ERN and P-OM3 alone improved characteristics of metabolic syndrome; whereas subjects on combination therapy did not have improved vascular stiffness, TG and HDL levels improved as did certain lipoprotein subfractions.—Shearer, G. Effects of prescription niacin and omega-3 fatty acids on lipids and vascular function in metabolic syndrome: a randomized controlled trial. Metabolic syndrome is defined by central obesity, elevated triglyceride (TG) levels, decreased HDL cholesterol (HDL-C) levels, and mild elevations of glucose and blood pressure; numerous physiologic dysfunctions contribute to the overall pathology. Niacin has been shown to reverse atherosclerosis [10] and reduce risk for CHD and mortality [11] [ the AIM-HIGH trial with niacin was stopped
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