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American Heart Association Late Breaking Clinical Trial Report: In Patients on Statins, Raising Good Cholesterol with Niacin, but not Reducing Bad Cholesterol with Ezetimibe, Decreases Plaque Build-Up
Date:11/15/2009

up as compared to the niacin group (5 percent vs. 1 percent).

HDL And LDL Treatment Strategies (HALTS) was a prospective, randomized, parallel group, open-label, blinded endpoint study conducted at Walter Reed Army Medical Center in Washington, D.C., and Washington Adventist Hospital in Tacoma Park, Md. It included 363 adults (80 percent male, average age 68 years) with or at high risk for atherosclerotic cardiovascular disease.

All participants were on cholesterol-lowering statin drugs, and their LDL cholesterol was at the treatment goal of under 100 milligrams per deciliter (mg/dL) of blood. Their HDL cholesterol was lower than 50 mg/dL for men and 55 mg/dL for women.

The researchers randomly assigned the subjects to receive either niacin or ezetimibe in addition to their usual statin. The primary endpoint was the change in the wall thickness of the carotid artery in the neck between the two groups of patients. In June, researchers halted the trial early because the primary endpoint was met. Specifically, 14-month follow-up data on 208 patients showed that in the niacin group, average HDL cholesterol rose from 42 mg/dL to 50 mg/dL and there was a significant regression in artery wall thickness. In the ezetimibe group, average LDL cholesterol levels dropped from 83 mg/dL to 66 mg/dL; however no overall change was found in average artery wall thickness.

LDL cholesterol is generally linked to the buildup of plaque in the arteries, which makes them more likely to become narrowed, and can lead to heart attack or stroke. HDL cholesterol helps clear LDL cholesterol from the blood in a process called reverse cholesterol transport.

"These findings for ezetimibe are counter to the prevailing understanding of LDL cholesterol -- that lowering LDL cholesterol results in slowing of the atherosclerotic process as has been convincingly shown for other classes of lipid modifying drugs, such as statins an
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SOURCE American Heart Association
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