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Pharmacological measures to increase HDL-C among high risk isolated low HDL cases: a randomized study amongst north
Sudeep Kumar1, Himanshu Rai, Aditya Kapoor
1Department of Cardiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
Insights
Niacin effectively increases high-density lipoprotein cholesterol (HDL-C) and reduces coronary heart disease (CHD) risk in patients with isolated low HDL-C (ILHDL-C). This study found niacin superior to fenofibrate and atorvastatin for improving HDL-C levels and lowering CHD risk.
Area of Science:
- Cardiology
- Pharmacology
- Lipid Metabolism
Background:
- Low high-density lipoprotein cholesterol (HDL-C) is a significant risk factor for coronary heart disease (CHD).
- Identifying optimal pharmacologic therapy to increase HDL-C in high-risk individuals with isolated low HDL-C (ILHDL-C) is crucial.
Purpose of the Study:
- To compare the efficacy of atorvastatin, fenofibrate, and niacin in raising HDL-C levels.
- To assess the impact of these drugs on reducing the estimated 10-year CHD risk percentage (CHD-RP) in high-risk ILHDL-C patients in North India.
Main Methods:
- A randomized study involving 200 patients with CHD risk equivalent (CHD-RP≥20) and ILHDL-C.
- Patients received atorvastatin (10 mg/day), micronized fenofibrate (160 mg/day), or niacin-extended release (ER) (750 mg/day) for 12 weeks, with dosages doubled after 6 weeks.
- Lipid values and CHD-RP were assessed at the end of the study.
Main Results:
- Niacin significantly increased HDL-C by 8.10% (750 mg) and 12.41% (1.5 g/day) (P<0.001).
- Fenofibrate also significantly increased HDL-C by 3.85% (160 mg) and 6.24% (320 mg) (P<0.001).
- Atorvastatin showed a non-significant increase in HDL-C (0.13% at 10 mg, 0.51% at 20 mg). Niacin was most effective in reducing CHD-RP, followed by fenofibrate; atorvastatin had no effect.
Conclusions:
- Niacin therapy is a safe and effective option for increasing HDL-C levels.
- Niacin demonstrates superior efficacy compared to fibrates and statins in reducing cumulative CHD risk among ILHDL-C patients.
- These findings support niacin as a preferred therapeutic agent for managing ILHDL-C to mitigate cardiovascular risk.
Background & Objectives:
Low serum levels of high density lipoprotein cholesterol (HDL-C) is an established risk factor for coronary heart disease (CHD). Among a variety of lipid modifying drugs, the best single drug therapy to increase HDL-C levels, especially among high risk, isolated low HDL-C (ILHDL-C) cases is yet to be identified. The objectives of the present study were to evaluate the best pharmacological measure among atorvastatin, fenofibrate and niacin aimed to raise HDL-C and its effect in decreasing the estimated Framingham-10-year CHD risk percentage (CHD-RP) among high risk ILHDL-C cases in north India.
Methods:
Two hundred CHD equivalent (CHD-RP≥20), ILHDL-C cases were randomly assigned for treatment either with atorvastatin 10 mg/day (n=70), micronized fenofibrate 160 mg/day (n=65) or niacin-extended release (ER) 750 mg/day (n=65). After 6 wk of treatment, the dosages of drugs were doubled and the patients were finally assessed after 12 wk for their lipid values.
Results:
Baseline characteristics were similar in the three groups. Niacin therapy 750 mg and 1.5 g/day resulted in a significant rise in HDL-C by 8.10 ± 3.19 and 12.41 ± 4.39 per cent (P<0.001), respectively. Fenofibrate 160 and 320 mg/day also resulted in a significant rise in HDL-C by 3.85 ± 3.48 and 6.24 ± 4.43 per cent (P<0.001), respectively, while atorvastatin 10 and 20 mg/day resulted in a non-significant increase in HDL-C by 0.13 ± 2.92 per cent and 0.51 ± 2.63 per cent, respectively. By increasing HDL-C values, niacin was found to be most effective in reduction of 10-year CHD-RP (P<0.001), followed by fenofibrate (P=0.010), while atorvastatin had no effect.
Interpretation & Conclusions:
Our findings indicate that niacin rather than fibrates or statins seems to provide a safe and effective therapy for increasing HDL-C, thus reducing the cumulative CHD risk among ILHDL-C cases.
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