Abstract
Background. Niacin is the most effective treatment currently available for raising HDL-C levels. Objective. To evaluate if gender and baseline lipid levels have an effect on the HDL-C response of niacin ER and to identify factors that predict response to niacin ER at the 500 mg dose. Material and Methods. The change in HDL-C effect between baseline and follow-up levels was quantified in absolute change as well as dichotomized into high versus low response (high response was defined as an HDL-C effect of >15% increase and low response was HDL-C <5%) in a sample of 834 individuals. Results. Both males and females with low HDL-C levels at baseline exhibited a response to treatment in the multivariate model (males, HDL-C <40 mg/dL: OR = 5.18, 95% CI: 2.36–11.39; females, HDL-C <50 mg/dL: OR = 5.40, 95% CI: 1.84–15.79). There was also a significant difference in the mean HDL-C effect between baseline and follow-up HDL-C levels in the 500 mg niacin ER dose group for both males (mean HDL-C effect = 0.08, P < 0.001) and females (mean HDL-C effect = 0.10, P = 0.019). Conclusion. Baseline HDL-C levels are the biggest predictor of response to niacin ER treatment for both males and females among the factors evaluated.
Highlights
High-density lipoprotein cholesterol (HDL-C), referred to as the “good cholesterol,” is a known antioxidant, antithrombotic, and antiinflammatory, with properties that promote the removal of cellular cholesterol [1]
Individuals with low HDL-C levels may be at an increased risk of coronary heart disease (CHD) [2], and it has been shown in observational studies that the risk of CHD is reduced by 2%3% for every 1 mg/dL increase in HDL-C [3]
Recently published results from the Atherothrombosis Intervention in Metabolic Syndrome with Low HDL Cholesterol/High Triglyceride and Impact on Global Health Outcomes (AIM-HIGH) study showed that high-dose niacin ER did not provide additional reduction in risk of cardiovascular-related events beyond what is observed with statin therapy alone [4]
Summary
High-density lipoprotein cholesterol (HDL-C), referred to as the “good cholesterol,” is a known antioxidant, antithrombotic, and antiinflammatory, with properties that promote the removal of cellular cholesterol [1]. Recently published results from the Atherothrombosis Intervention in Metabolic Syndrome with Low HDL Cholesterol/High Triglyceride and Impact on Global Health Outcomes (AIM-HIGH) study showed that high-dose niacin ER did not provide additional reduction in risk of cardiovascular-related events beyond what is observed with statin therapy alone [4]. In this modest sized trial, 3,414 subjects were randomized to niacin ER or placebo while their low-density lipoprotein cholesterol (LDL-C) levels were maintained to a median of
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