Combination of niacin extended-release and simvastatin results in a less
atherogenic lipid profile than atorvastatin monotherapy.
Author(s): Insull W Jr, Toth PP, Superko HR, Thakkar RB, Krause S, Jiang P, Parreno RA,
Padley RJ.
Affiliation(s): Baylor College of Medicine and Methodist Hospital, Houston, Texas, USA.
Publication date & source: 2010, Vasc Health Risk Manag. , 6:1065-75
OBJECTIVE: To compare the effects of combination niacin extended-release +
simvastatin (NER/S) versus atorvastatin alone on apolipoproteins and lipid
fractions in a post hoc analysis from SUPREME, a study which compared the lipid
effects of niacin extended-release + simvastatin and atorvastatin in patients
with hyperlipidemia or mixed dyslipidemia.
PATIENTS AND METHODS: Patients (n = 137) with dyslipidemia (not previously
receiving statin therapy or having discontinued any lipid-altering treatment 4-5
weeks prior to the study) received NER/S (1000/40 mg/day for four weeks, then
2000/40 mg/day for eight weeks) or atorvastatin 40 mg/day for 12 weeks. Median
percent changes in apolipoprotein (apo) A-1, apo B, and the apo B:A-I ratio, and
nuclear magnetic resonance lipoprotein subclasses from baseline to week 12 were
compared using the Wilcoxon rank-sum test and Fisher's exact test.
RESULTS: NER/S treatment produced significantly greater percent changes in apo
A-I and apo B:A-I, and, at the final visit, apo B < 80 mg/dL was attained by 59%
versus 33% of patients, compared with atorvastatin treatment (P = 0.003). NER/S
treatment resulted in greater percent reductions in calculated particle numbers
for low-density lipoprotein (LDL, 52% versus 43%; P = 0.022), small LDL (55%
versus 45%; P = 0.011), very low-density lipoprotein (VLDL) and total
chylomicrons (63% versus 39%; P < 0.001), and greater increases in particle size
for LDL (2.7% versus 1.0%; P = 0.007) and VLDL (9.3% versus 0.1%; P < 0.001),
compared with atorvastatin.
CONCLUSION: NER/S treatment significantly improved apo A-I levels and the apo
B:A-I ratio, significantly lowered the number of atherogenic LDL particles and
VLDL and chylomicron particles, and increased the mean size of LDL and VLDL
particles, compared with atorvastatin.
|