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50-year-old cholesterol medication makes a comeback?

Posted Dec 07 2009 6:41pm

 A recent cholesterol trial called ARBITER 6-HALTS was discussed at the American Heart Association national meeting and published in the New England Journal of Medicine last month. Three hundred and sixty three men and women with known heart disease or vascular disease were enrolled in this study. All of the patients LDL (bad) cholesterol levels were < 100 mg/dl (goal LDL in this high risk group is < 70) so the LDL was good but could be better. Their HDL (good) cholesterol levels were acceptable but a little low (< 50 mg/dl). When HDL levels are low patients are not receiving adequate protection against heart disease and stroke. Half of the patients received treatment with ezetimibe (Zetia) in addition to a statin treatment to further lower LDL levels. The remaining patients received extended-release niacin in addition to a statin to improve HDL levels. So this study set out to see which treatment would be more beneficial – further lowering of LDL (bad) cholesterol or raising HDL (good) cholesterol in a high-risk group of patients.

After 14 months of treatment cholesterol results improved in both patients receiving ezetimibe and patients receiving niacin. The interesting finding was the niacin patients had a reversal of plaque inside the blood vessels in the neck; this was measured by a test called carotid IMT. The patients in the ezetimibe (Zetia) group surprisingly did not experience the same benefit. This was a small study but clearly suggests that niacin, which is a 50-year-old medication, may be more beneficial than some of the newer medications like ezetimibe. Remember all of these patients were also receiving a statin medication for cholesterol management. Unfortunately many patients are unable to tolerate high doses of niacin due to the side effects. Niacin is an inexpensive medication and available over the counter but we recommend you talk with your health care provider before starting niacin treatment.

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