Giugliano noted that another, larger trial of niacin is in progress, results of which are expected in 2013.
Niacin might be useful for patients who cannot take statins, he said. "So niacin may still have a role," he added.
However, Giugliano does not recommend patients start taking niacin. "One brand, Niaspan, sold almost $800 million worth last year. But, it's hard to support high-volume sales for a drug that doesn't have any good recent data to support it," he said.
The trial was funded by the U.S. National Heart, Lung, and Blood Institute with support from Abbott Laboratories, which provided the Niaspan. Drug maker Merck Pharmaceuticals provided the Zocor.
Another expert, Dr. Gregg Fonarow, a professor of cardiology at the University of California, Los Angeles, and a spokesman for the American Heart Association, commented that "LDL-lowering with statin therapy dramatically lowers the risk of cardiovascular events in patients with established coronary heart disease."
It has been commonly held that raising HDL and lowering triglyceride levels would be beneficial, even among patients who have achieved optimal levels with statin therapy, he said. LDL is known as "bad cholesterol."
"AIM-High has demonstrated that among patients with established cardiovascular disease, there was no clinical benefit with the addition of extended release niacin to statin therapy despite increases in HDL and decreases in triglyceride. Further there was an unexpected increase in stroke risk with niacin," Fonarow said.
"These findings challenge the commonly held hypothesis that HDL raising and triglyceride lowering is of benefit to patients with coronary heart disease, though further studies are needed," he added.
Aggressive LDL-lowering with statin therapy remains the evidence-based, guideline-recommended, gold standard for benefiting patients with and at
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