Lipid Lowering Therapy with Combination of Niacin and Statin in Women: Age-Related Endothelial Effects

Beth A Parker ,Kamlesh Kothawade,Namee Kim,Maura Paul-Labrador,Noel Bairey Merz ,Donna M Polk

doi:10.1155/2013/168504

Beth A Parker , Kamlesh Kothawade + Show 4 more

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https://doi.org/10.1155/2013/168504

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Abstract

Background. Many women remain at risk for cardiac events despite treatment to reduce low-density lipoprotein cholesterol (LDL-C). We hypothesized that for postmenopausal women treated with niacin in addition to statin vascular function will improve. Methods. We conducted a randomized, double-blind, placebo-controlled trial of 16 weeks of niacin (N) versus placebo (PL) in 43 women (mean age, 67±9 years) previously on statin therapy. Study outcomes included lipoprotein levels, vascular inflammation assessed by high sensitivity C-reactive protein (hsCRP), interleukin 6 (IL-6), tumor necrosis factor α (TNF-α), and endothelial function, assessed as brachial artery flow mediated dilation (FMD). Results. The N group significantly increased HDL-C and decreased LDL-C cholesterol relative to PL (both P<0.01). FMD improved in both groups (P=0.02) irrespective of niacin (P=0.21). Age influenced change in FMD (P=0.01) such that improved FMD (before to after) with lipid lowering therapy was greater with older age (P=0.03 Pearson correlation = 0.34), independent of treatment group. Conclusions. Lipid lowering therapy with combination of niacin and statin does not improve inflammation or endothelial function compared to statin alone. However, older women demonstrate relatively greater endothelial benefit of lipid lowering therapy over 4 months. This trial is registered with Clinicaltrials.gov NCT00590629.

Highlights

Cardiovascular disease (CVD) remains the most common cause of death in women, yet our current fund of CVD knowledge in women is relatively limited [1]
Recent evidence suggests that additional lipid fractions, high levels of small dense LDL-C, triglycerides, very-low-density lipoprotein cholesterol (VLDL-C), and low HDL-C identify a group at risk for progression of atherosclerosis and future cardiac events [9,10,11,12]
The purpose of the current study was to investigate the effect of combined HDL-C elevation, triglyceride lowering, and further LDL-C reduction accomplished by the addition of niacin to statin medication as compared to low-density lipoprotein cholesterol (LDLC) reduction alone in women with or at risk for CVD and the effect of the combination of low HDL-C/high triglycerides on endothelial function and inflammatory biomarkers

Summary

Introduction

Cardiovascular disease (CVD) remains the most common cause of death in women, yet our current fund of CVD knowledge in women is relatively limited [1]. Primarily in the form of LDL-C lowering, has been demonstrated to result in significant 30% reduction in cardiac events [6, 7], possibly with relatively less benefit in women [8]. The Veterans Affairs Cooperative Studies Program High-Density Lipoprotein Cholesterol Intervention Trial (VA-HIT) demonstrated that HDL-C elevation via the use of gemfibrozil resulted in a significant 25% reduction in the combined events of death and myocardial infarction (MI) in men with coronary disease and modest elevations in LDL-C [13]. Older women demonstrate relatively greater endothelial benefit of lipid lowering therapy over 4 months This trial is registered with Clinicaltrials.gov NCT00590629

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