Niacin superior to ezetimibe in decreasing CIMT

Patients with coronary heart disease (CHD) or CHD equivalent on stable statin monotherapy treated with the addition of extended-release niacin have significant decreases in carotid intima-media thickness (CIMT) compared with those who had ezetimibe added to their stable statin treatment, according to a study published online April 14 in the Journal of the American College of Cardiology, as reported by HealthDay News.

Todd C. Villines, MD, of the Walter Reed Army Medical Center, Washington, D.C., and colleagues conducted the Arterial Biology for the Investigation of the Treatment Effects of Reducing Cholesterol 6–HDL and LDL Treatment Strategies in Atherosclerosis (ARBITER6-HALTS) trial, which was terminated early because of the results of an interim analysis that found niacin superior to ezetimibe in CIMT change.

The study included results from 315 patients-208 patients who completed 14 months of follow-up and 107 patients who completed a close-out assessment after the trial was terminated (mean treatment of 7 months ±3 months).

The researchers found that niacin at a target dose of 2,000 mg/d resulted in significant decreases in both mean and maximal CIMT. Ezetimibe given at 10 mg/day dose did not result in either mean or maximal CIMT regression.

Increased cumulative drug exposure, calculated by factoring in drug adherence, dosage, and treatment duration for each patient, was associated with regression of CIMT for those on niacin and progression of CIMT for those on ezetimibe.

“These results strengthen the findings from the interim analysis through the inclusion of patients treated for shorter times (last observation carried forward analysis), which might have been expected to reduce the magnitude of effect between the two treatment strategies originally observed,” the authors write.

Abbott Pharmaceuticals funded the study, and several of the study authors disclosed financial relationships with Abbott or other pharmaceutical companies.