Flushing and the HDL-C response to extended-release niacin
Received 23 January 2008; accepted 7 February 2008. published online 20 May 2008.
Background
Several lines of evidence suggest that a linkage between niacin efficacy and flushing is plausible.
Objective
To examine the relationship between niacin-induced flushing and clinical endpoints among participants of the Arterial Biology for the Investigation of the Treatment Effects of Reducing Cholesterol (ARBITER) 2 study.
Methods
Seventy-seven subjects were randomized to extended-release niacin (1 g/day) and completed the 12-month endpoint assessment of ARBITER 2. The relationships between self-reported flushing and changes in high-density lipoprotein cholesterol (HDL-C) and change in carotid intima-media thickness (CIMT) at 12 months were evaluated.
Results
Flushing was reported by 53 subjects (68.8%) over 12 months. Mean increases in HDL-C at 12 months were significantly greater among subjects with flushing versus those without flushing (7.3 ± 6.6 vs 4.0 ± 6.9 mg/dL; P < 0.05). On multivariate analysis, HDL-C increase was significantly associated with self-reported flushing, controlling for age, gender, diabetes, baseline HDL-C and triglycerides, aspirin use, and medication adherence (P = 0.019). There was a nonsignificant trend for less progression of CIMT among subjects with flushing (0.011 ± 0.012 vs 0.033 ± 0.026 mm; P = 0.38). Medication adherence assessed by pill counts was high and was similar among those with (90%) and without (92%) flushing.
Conclusion
In the ARBITER 2 trial, niacin-induced flushing was independently associated with a greater HDL-C response and with a directional trend for slowed CIMT progression.
Cardiology Service, Walter Reed Army Medical Center, 6900 Georgia Avenue, NW Building 2, Room 4A34, Washington, DC 20307-5001, USA
Corresponding author.
The opinions or assertions herein are the personal views of the authors and are not to be construed as reflecting the views of the Department of the Army or the Department of Defense.
ABSTRACT