Nov. 14, 2000 NEW ORLEANS (Nov. 13) -- Treatment with a combination of statin and niacin can slash the risk of hospitalization for chest pain or a heart attack by 70 percent among patients who are likely to suffer heart attacks and/or death from cardiovascular problems, according to a study presented here by researchers at the University of Washington School of Medicine.
The treatment combines two already well-known ways of improving cardiac health: the use of a statin drug to lower levels of the "bad" cholesterol, LDL, and the use of niacin to boost levels of the "good" cholesterol, HDL.
The study found that use of this combined treatment, in people with low levels of good cholesterol and average levels of bad cholesterol, could even remove plaque buildup in the arteries. Cardiovascular disease is the No. 1 killer in the Western Hemisphere.
At the start of the study and again after three years of treatment, doctors took angiograms of the patients' arteries. The angiograms showed that in most of the patients who received the combination treatment, plaque buildup had actually decreased.
"This is the first demonstration of a striking clinical benefit from combination drug therapy for a common type of coronary disease patient," said Dr. B. Greg Brown, a cardiologist and UW professor of medicine.
Researchers are finishing up their analysis of the study data, and plan to submit their report this winter for publication. Brown is the study's lead author. The results were presented in New Orleans on Nov. 13 at the Scientific Sessions of the American Heart Association.
"This interesting study is a good demonstration of the enormous value of cholesterol management in patients with coronary disease," said Dr. Claude Lenfant, director of the National Heart, Lung, and Blood Institute, which funded the study.
The same study found that a mixture of antioxidant vitamins had no effect on cardiovascular outcomes. Scientists are not sure why this is so, since there has been laboratory evidence that suggests antioxidants should be helpful.
"More research and larger studies are needed to confirm the lack of effectiveness of antioxidant vitamins on risk for coronary events," Lenfant said.
Brown was involved in the first studies in the late 1980s that showed that a kind of statin, lovastatin, could reduce the occurrence of major cardiovascular events by about 25 to 35 percent. Giving statins to people with cardiovascular disease is now common.
"What you expect with statins is a slowing of the disease progression, but not a stopping. Arteries continue to get narrower, but not as fast," Brown said. "But when niacin is combined with a statin, the artery blocking actually improves, on average."
Brown and colleagues surmised that combining simvastatin with niacin might prevent even more heart attacks and such cardiac events. The goal would be to reduce plaque buildup. That's important because the cholesterol-rich plaque is what can clog artery walls and lead to fatal complications.
The statin lowers blood levels of LDL, which is called the "bad" cholesterol because it is more likely to clog ateries. Niacin, or Vitamin B3, is the best agent known to raise blood levels of HDL, which helps dissolve cholesterol deposits from the artery walls.
The 160 patients involved in the study had low levels of good HDL cholesterol (a level of 35 or less). At least four out of every 10 people with coronary artery disease fit this profile. But the study results may have implications for other people with coronary diseases. They would have even higher levels of HDL - and having higher levels of the good cholesterol should only help them, Brown said.
Some patients in this study received simvastatin and niacin, while others received antioxidants. A third group received three treatments while a fourth, control, group received placebos. All patients received exercise training and dietary counseling.
The results for those receiving statin and niacin were startlingly different than the others. The average level of HDL increased from 31 to 38, while the average LDL dropped from 125 to 76 -- that is considered an extremely good level of the bad cholesterol. Angiograms showed that most of these people had no additional plaque buildup over the years. In many of them, the amount of plaque actually decreased.
"What we saw was a reversal of the disease," Brown said. "The patients' arteries, on average, had stopped narrowing and begun to improve."
The study involved use of niacin at moderately high and carefully supervised levels. Brown said that people should only take niacin under a doctor's supervision, because in some patients, the doctor may wish to monitor the patient's liver. Rarely, the unsupervised use of niacin can cause severe liver problems, including liver failure.
The study had included antioxidants because there has been considerable evidence that they should help protect against the basic mechanisms for cholesterol buildup. The antioxidants involved in this study include Vitamins C, E, beta carotene and selenium.
Others involved in the study include UW researchers Dr. John Albers, Dr. Xue-Qiao Zhao, Dr. Alan Chait, Dr. Lloyd Fisher, Alice Dowdy, Dr. Marian Cheung, Josiah Morse, Leny Serafini and Ellen Huss-Frechette, as well as Debbie DeAngelis and Dr. Jiri Frohlich of the University of British Columbia, Vancouver, B.C.
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