Niaspan® in the management of dyslipidaemia: the evidence

Abstract

Simultaneous correction of hyperlipidaemia and low HDL-cholesterol may provide superior cardiovascular protection than a single pharmacological lipid-modifying strategy. Combinations of nicotinic acid (the most effective HDL-raising agent currently available) and a statin have been especially well studied. The HDL Atherosclerosis Treatment Study (HATS) demonstrated regression of atherosclerosis and a 60-90% reduction in cardiovascular event rates in patients with cardiovascular disease and low HDL-cholesterol who were randomized to receive a combination of immediate-release nicotinic acid and a statin when compared with patients randomized to placebo. Niaspan®, a prolonged-release formulation of nicotinic acid with superior tolerability to the immediate-release version also reduced the progression of atherosclerosis, in the Arterial Biology for the Investigation of the Treatment Effects of Reducing Cholesterol (ARBITER 2) study, although this trial was not powered to evaluate outcomes. The Atherothrombosis Intervention in Metabolic Syndrome with Low HDL-C/High Triglyceride and Impact on Global Health Outcomes (AIM-HIGH) study will test the hypothesis that treatment with Niaspan® plus a statin will provide superior cardiovascular outcomes to a statin given alone in a population of >3000 patients with vascular disease and atherogenic dyslipidaemia (low HDL-cholesterol and hypertriglyceridaemia). The results of AIM-HIGH will be available in 2010. However, the current clinical evidence base supports intensive intervention to correct low HDL-cholesterol today.