Coronary drug project: Experience with niacin

Abstract

Niacin was one of the treatments compared in the Coronary Drug Project, a placebo-controlled, multicenter trial of lipid-lowering drugs in the secondary prevention of coronary heart disease. A total of 1119 men, aged 30-64 at entry, were randomized to niacin and 2789 to placebo by the end of recruitment in March 1969. Although side-effects interfered with adherence to the niacin regimen, it was the most effective agent in achieving cholesterol-lowering (10% overall); other agents in the trial were clofibrate, dextrothyroxine, and conjugated equine estrogens. At the scheduled conclusion of the trial in February 1975, the niacin-treated group exhibited a statistically significantly lower incidence of definite, non-fatal myocardial infarction (MI) than the placebo group. There was a trend toward improvement in the life-table mortality curve, but this was not statistically significant. In 1981 an extended follow-up was carried out concerning vital status for the 6008 men who were still alive at the end of treatment and active follow-up in the trial in 1975 (827 in the niacin group and 2008 in placebo groups). Vital status was determined for 99.1% of these men after a mean of 9 years from conclusion of the trial. In the group previously randomized to niacin, there were 69 (11%) fewer deaths than were expected on the basis of mortality in the placebo group. This difference was significant (z = -3.52; P = 0.0004). The data also suggested that patients with a higher baseline cholesterol experienced greater benefit from niacin therapy, as did those with the best response to the drug.(ABSTRACT TRUNCATED AT 250 WORDS)

Focusing on High-Density Lipoprotein for Coronary Heart Disease Risk Reduction

“…Niacin was one of the first lipid-altering drugs to demonstrate a reduction in CHD events in the Coronary Drug Project. 28 At present, niacin is identified as the most effective HDL-raising therapy. Although the mechanism by which niacin raises HDL is not well understood, the predominant hypothesis is that niacin inhibits the holoparticle uptake of HDL, resulting in delayed catabolism.…”

Pharmacotherapy and HDL Cholesterol

“…Nonetheless over a 10 year follow up there was a 27% reduction in major coronary events (p<0.05). Extended follow up of those alive at the end of the trial revealed 11% fewer deaths (p<0.01) in those on niacin [74]. Better tolerability can be achieved with extended release niacin [75].…”

Statin and ezetimibe combination therapy in cardiovascular disease

“…Furthermore, this relationship exists for all statins, whether fungal metabolites or synthetic derivatives. In addition, other lipid-altering drugs such as bile acid sequestrants [12], niacin [13], and fibrates [14] have been demonstrated to lower cardiovascular events to a degree similar to statin therapy when adjusted for cholesterol reduction.…”