Abstract 685: Comparative Effect of Statins vs Niacin on MRI Measured Regression of Carotid Atherosclerosis in a Randomized Clinical Trial: The NIA Plaque Study
Background: Increased levels of high density lipoprotein (HDL) correlate with decreased risk of cardiovascular events. Extended release (ER) niacin has been demonstrated to increase HDL levels. The effect of ER niacin in addition to statin based therapy on atherosclerosis regression remains unclear.
Methods: 157 patients over age 65 with clinically evident atherosclerosis were randomized to receive either ER niacin 1500 mg daily or a placebo. All patients received statin therapy as needed to reach NCEP ATP III-revised LDL targets. The right and left internal carotid arteries (ICAs) were imaged in T2 weighted black blood sequences using a 1.5 T MR scanner. Carotid wall plaque was measured at baseline and every 6 months on therapy.117 participants (74%) completed 18 months of follow up.
Results: ER niacin, in comparison to placebo, resulted in significantly lower LDL (67 mg/dL vs 77 mg/dL, p =0.03) and higher HDL (58 mg/dL vs 49 mg/dL, p <0.001) at 18 months. Both groups demonstrated significant reductions in the volume of carotid atherosclerosis. The statin + placebo group had a 0.07 mm3/month decline (p= 0.006) in MR measured wall volume. The statin + ER niacin group had a 0.1 mm3/month regression of wall volume (p<0.001). There was no significant difference in plaque regression between treatment groups.
Conclusions: Treatment of this secondary-prevention population with statin therapy with and without ER niacin produced significant reduction in carotid atherosclerosis. The addition of ER niacin, despite relative improvements in HDL and LDL cholesterol, did not provide further benefit.