"Fifteen year mortality in Coronary Drug Project patients; long term benefit with niacin" Cardiovasc Diabetol. Folsom A.R., Kronmal R.A., Detrano R.C.et al.  |  Regression of carotid plaque was seen with aggressive standard medical therapy including statins, but a similar degree of regression occurred in both the niacin … . Please enable it to take advantage of the complete set of features! . This viewpoint summarizes these imaging trials studying niacin and places them in the context of the failure of AIM-HIGH to support the HDL-C-increasing hypothesis. It remains unclear whether strategies aimed at increasing HDL-C in addition to background statin therapy will further reduce risk. Perhaps in these predominantly statin-treated patients generally at lipid goals, coronary plaque might have already been depleted of its lipid core. The ACCORD Study Group: In addition, it remains unclear whether a reduction in cIMT progression or actual regression obtained with a pharmacological treatment is necessarily followed by a decrease in coronary atherosclerosis and events. "HDL cholesterol, very low levels of LDL cholesterol, and cardiovascular events" Cannon C.P., Giugliano R.P., Blazing M.A.et al. The Oxford Niaspan study (10) was a smaller (N = 71) RCT of modified-release niacin (target 2,000 mg/day) versus placebo added to baseline statin therapy on the primary endpoint of change in common carotid artery wall area by magnetic resonance imaging at 1 year. Despite substantial risk reductions targeting low-density lipoprotein cholesterol with statins, there remains significant residual risk as evidenced by incident and recurrent cardiovascular disease (CVD) events among statin-treated patients. The SANDS (Stop Atherosclerosis in Native Diabetics Study) compared the effects of aggressive LDL-C–lowering strategy (target LDL-C goal <70 mg/dl) with those of a standard-treated group (LDL-C goal <100 mg/dl) (26). Costanzo P., Perrone-Filardi P., Vassallo E.et al. "Effects of torcetrapib in patients at high risk for coronary events" Nissen S.E. The results of AIM-HIGH are disappointing. Because niacin has LDL-C–lowering effects, this meant greater use of higher simvastatin doses in the placebo arm (25% of the placebo arm was taking simvastatin 80 mg vs. 18% of the niacin arm, p = 0.02) and also more ezetimibe in the placebo arm (22% vs. 10%, p < 0.001), which likely also confounded the results. Despite AIM-HIGH, the verdict is not yet in for niacin because there is still a much larger niacin RCT in progress. Differences between the study results may be due: 1) the site imaged; 2) differences in the primary outcome; 3) differences in baseline HDL-C values; or 4) differences in LDL-C achieved on therapy. 27. In secondary prevention patients, the evidence supports initially increasing doses of a statin to reach LDL-C goals. Regression of carotid plaque was seen with aggressive standard medical therapy including statins, but a similar degree of regression occurred in both the niacin and placebo arms. "Rationale and design of IMPROVE-IT (IMProved Reduction of Outcomes: Vytorin Efficacy International Trial): comparison of ezetimibe/simvastatin versus simvastatin monotherapy on cardiovascular outcomes in patients with acute coronary syndrome", "Effect of statins alone versus statins plus ezetimibe on carotid atherosclerosis in type 2 diabetes: the SANDS (Stop Atherosclerosis in Native Diabetic Study) trial", "HDL cholesterol, very low levels of LDL cholesterol, and cardiovascular events", Journal of Developmental Origins of Health and Disease, The Impact of Nutrition and Statins on Cardiovascular Diseases, Arteriosclerosis, Thrombosis, and Vascular Biology, Canadian Journal of Physiology and Pharmacology, BMC Complementary and Alternative Medicine, Current Opinion in Endocrinology & Diabetes and Obesity. Taylor A.J., Sullenberger L.E., Lee H.J., Lee J.K. and Grace K.A. There are other therapeutic agents under investigation targeting HDL-C (2). Although the HALTS trial (9) and the Oxford Niaspan Study (10) suggested niacin conferred more regression of carotid disease (cIMT or wall area) compared with ezetimibe or placebo, preliminary data from NIA Plaque study (11) showed that in an older, generally well-treated group, the addition of niacin failed to offer incremental benefit over statin therapy. . 6. In the JELIS (Japan EPA Lipid Intervention Study) study, there was an incremental benefit of adding eicosapentaenoic acid supplements to background statin therapy with a decrease in CVD events by 19% among patients with a history of CHD (23).

Where To Buy Buffalo Chicken Pizza Rolls, Synonym For Farmland, A Minor Blues Scale Notes, Pepperoni And Mozzarella Recipes, Paneer Makhani Recipe, Washington Manual App, Weber Gourmet Bbq System Spirit 200, Zima Tomatoes Vs Cherry Tomatoes, Roccat Vulcan Replacement Keys, What Is The Main Difference Between Economics And Economic Anthropology, Homemade Pizza Rolls In Air Fryer, Rolling Shutter Dimensions, Se X1 Frequency Response Chart, Optumrx Specialty Pharmacy,