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Role of Nicotinic Acid in Atherosclerosis Prevention

Thomas F. Whayne Jr, MD, PhD1
[+] Author Affiliations
1Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington
JAMA Intern Med. 2014;174(4):648-649. doi:10.1001/jamainternmed.2013.12651.
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To the Editor Jackevicius et al1 recently published concerns that nicotinic acid use in the United States, especially extended-release niacin (Niaspan; AbbVie Inc), exceeds almost 6-fold of that in Canada. Their economic comparison and implied excess use was stimulated by the AIM-HIGH (the Atherothrombosis Intervention in Metabolic syndrome with low HDL [high-density lipoprotein]/high triglycerides: Impact on Global Health outcomes) and HPS-2-THRIVE (Heart Protection Study 2–Treatment of HDL to Reduce the Incidence of Vascular Events) studies. The AIM-HIGH study reported that in patients with atherosclerotic cardiovascular disease (CVD) already treated with a statin to a low-density lipoprotein cholesterol (LDL-C) level of 71 mg/dL (to convert to millimoles per liter, multiply by 0.0259), no incremental benefit occurred with the addition of nicotinic acid to a statin therapy over 36 months. In HPS-2 THRIVE (starting LDL-C level of 63 mg/dL), nicotinic acid, combined with the antiflushing agent laropiprant, did not decrease CVD risk further in the presence of statin therapy.1 Both studies involved patients with proven CVD receiving statin therapy and essentially at the LDL-C target for high–CVD risk patients (<70 mg/dL). Showing significant benefit when already at the desired LDL-C target is problematic. Nevertheless, such results must be analyzed and answered.1

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April 1, 2014
Cynthia A. Jackevicius, BScPhm, PharmD, MSc, BCPS; Harlan M. Krumholz, MD, SM
1Department of Pharmacy Practice and Administration, College of Pharmacy, Western University of Health Sciences, Pomona, California2Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada3Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada4Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California5University Health Network, Toronto, Canada
6Department of Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut7Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut8Department of Epidemiology and Public Health, Section of Health Policy and Administration, New Haven, Connecticut9Robert Wood Johnson Clinical Scholars Program, New Haven, Connecticut
JAMA Intern Med. 2014;174(4):649. doi:10.1001/jamainternmed.2013.12811.
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