Lowering LDL cholesterol with statin medications (simvastatin, atorvastatin, and others) has been proven to reduce heart disease and all cause mortality in patients with elevated LDL cholsterol.
But we know that high LDL cholesterol levels can’t be whole story. A low HDL cholesterol level also predicts increased risk of heart disease.
Extended-release niacin (Niaspan) increases the HDL level. And so for many years we have believed that Niaspan might lower the risk of heart disease in pts with a low HDL cholesterol level.
But it turns out that, even though a low HDL cholesterol predicts increased cardiovascular risk, raising the HDL cholesterol with Niaspan does not lower that risk of heart disease. These results are reported in the AIM-HIGH study in the November 15, 20ll New England Journal of Medicine available at
https://www.nejm.org/doi/pdf/10.1056/NEJMoa1107579
Dr. Guiglaino, in an accompanying editorial on AIM-HIGH study concludes that “. . . the disappointing results of AIM-HIGH do not provide support for the use of niacin as an add-on therapy to statins in patients with preexisting stable cardiovascular disease who have well-controlled LDL cholesterol levels.”
The editorial, Niacin at 56 years of age—Time for an Early Retirement?, is available at
https://www.nejm.org/doi/pdf/10.1056/NEJMe1112346
The AIM-HIGH study shows once again that just because we think a medicine or treatment should help, that does not mean it actually does helps patients. To know if a medicine really helps patients, we need proof.
