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CLINICAL RESEARCH: VASCULAR EFFECTS OF NICOTINIC ACID

Effects of High-Dose Modified-Release Nicotinic Acid on Atherosclerosis and Vascular Function

A Randomized, Placebo-Controlled, Magnetic Resonance Imaging Study

Justin M.S. Lee, MB, BCh^_*, Matthew D. Robson, PhD^_*, Ly-Mee Yu, MSc, Cheerag C. Shirodaria, MD^_*, Colin Cunnington, MBBS^_*, Ilias Kylintireas, MD^_*, Janet E. Digby, PhD^_*, Thomas Bannister, BA^_*, Ashok Handa, MB, BS, Frank Wiesmann, MD^_*, Paul N. Durrington, MD, Keith M. Channon, MD^_*, Stefan Neubauer, MD^_* and Robin P. Choudhury, DM^_*,_*

^_* Department of Cardiovascular Medicine, University of Oxford and Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Oxford, United Kingdom
Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom
Nuffield Department of Surgery, University of Oxford, Oxford, United Kingdom
Cardiovascular Research Group, University of Manchester, Manchester, United Kingdom

Manuscript received February 3, 2009; revised manuscript received May 26, 2009, accepted June 18, 2009.

^_* Reprint requests and correspondence: Dr. Robin P. Choudhury, Department of Cardiovascular Medicine, Level 6, West Wing, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom (Email: robin.choudhury{at}cardiov.ox.ac.uk).

Objectives: Our aim was to determine the effects of high-dose (2 g) nicotinic acid (NA) on progression of atherosclerosis and measures of vascular function.

Background: NA raises high-density lipoprotein cholesterol (HDL-C) and reduces low-density lipoprotein cholesterol and is widely used as an adjunct to statin therapy in patients with coronary artery disease. Although changes in plasma lipoproteins suggest potential benefit, there is limited evidence of the effects of NA on disease progression when added to contemporary statin treatment.

Methods: We performed a double-blind, randomized, placebo-controlled study of 2 g daily modified-release NA added to statin therapy in 71 patients with low HDL-C (<40 mg/dl) and either: 1) type 2 diabetes with coronary heart disease; or 2) carotid/peripheral atherosclerosis. The primary end point was the change in carotid artery wall area, quantified by magnetic resonance imaging, after 1 year.

Results: NA increased HDL-C by 23% and decreased low-density lipoprotein cholesterol by 19%. At 12 months, NA significantly reduced carotid wall area compared with placebo (adjusted treatment difference: –1.64 mm² [95% confidence interval: –3.12 to –0.16]; p = 0.03). Mean change in carotid wall area was –1.1 ± 2.6 mm² for NA versus +1.2 ± 3.0 mm² for placebo. In both the treatment and placebo groups, larger plaques were more prone to changes in size (r = 0.4, p = 0.04 for placebo, and r = –0.5, p = 0.02 for NA).

Conclusions: In statin-treated patients with low HDL-C, high-dose modified-release NA, compared with placebo, significantly reduces carotid atherosclerosis within 12 months. (Oxford Niaspan Study: Effects of Niaspan on Atherosclerosis and Endothelial Function; NCT00232531 [ClinicalTrials.gov] )

Key Words: carotid • atherosclerosis • HDL cholesterol • magnetic resonance imaging

Abbreviations and Acronyms   CI = confidence interval   CRP = C-reactive protein   HDL-C = high-density lipoprotein cholesterol   IMT = intima-media thickness   LDL-C = low-density lipoprotein cholesterol   MRI = magnetic resonance imaging   NA = nicotinic acid

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