Effects of High-Dose Modified-Release Nicotinic Acid on Atherosclerosis and Vascular Function A Randomized, Placebo-Controlled, Magnetic Resonance Imaging Study
Effects of High-Dose Modified-Release Nicotinic Acid on Atherosclerosis and Vascular Function A Randomized, Placebo-Controlled, Magnetic Resonance Imaging Study
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DOI：
10.1016/j.jacc.2009.06.036
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发表时间：
2009-11-03
影响因子：
24
通讯作者：
Choudhury, Robin P.
中科院分区：
文献类型：
--
作者：
Lee, Justin M. S.;Robson, Matthew D.;Choudhury, Robin P.
我们的目的是确定高剂量（2g）烟酸（NA）对动脉粥样硬化进展和血管功能测量的影响。NA可提高高密度脂蛋白胆固醇（HDL-C），降低低密度脂蛋白胆固醇，广泛用于冠状动脉疾病患者他汀类药物治疗的辅助治疗。虽然血浆脂蛋白的变化提示潜在的益处，但在当代他汀类药物治疗中加入NA对疾病进展的影响的证据有限。方法：我们对71例低HDL-C （< 40 mg/dl）患者进行了一项双盲、随机、安慰剂对照研究：1)2型糖尿病合并冠心病；2)颈动脉/外周动脉粥样硬化。主要终点是1年后颈动脉壁面积的变化，通过磁共振成像量化。结果NA使HDL-C升高23%，使低密度脂蛋白胆固醇降低19%。在12个月时，与安慰剂相比，NA显著减少颈动脉壁面积(调整后的治疗差异：-1.64 mm(2)[95%置信区间：-3.12至-0.16]；P = 0.03)。NA组颈动脉壁面积的平均变化为-1.1 +/- 2.6 mm(2)，而安慰剂组为+1.2 +/- 3.0 mm(2)。在治疗组和安慰剂组中，较大的斑块更容易发生大小变化（安慰剂组r = 0.4, p = 0.04， NA组r = -0.5, p = 0.02）。结论在接受他汀类药物治疗的低HDL-C患者中，与安慰剂相比，大剂量改良释放NA可在12个月内显著减少颈动脉粥样硬化。（Oxford Niaspan Study: Niaspan对动脉粥样硬化和内皮功能的影响；NCT00232531） （J Am col Cardiol 2009;54:1787-94） (c) 2009 by American College of Cardiology Foundation
Objectives Our aim was to determine the effects of high-dose (2 g) nicotinic acid (NA) on progression of atherosclerosis and measures of vascular function.Background NA raises high-density lipoprotein cholesterol (HDL-C) and reduces low-density lipoprotein cholesterol and is widely used as an adjunct to statin therapy in patients with coronary artery disease. Although changes in plasma lipoproteins suggest potential benefit, there is limited evidence of the effects of NA on disease progression when added to contemporary statin treatment.Methods We performed a double-blind, randomized, placebo-controlled study of 2 g daily modified-release NA added to statin therapy in 71 patients with low HDL-C (< 40 mg/dl) and either: 1) type 2 diabetes with coronary heart disease; or 2) carotid/peripheral atherosclerosis. The primary end point was the change in carotid artery wall area, quantified by magnetic resonance imaging, after 1 year.Results NA increased HDL-C by 23% and decreased low-density lipoprotein cholesterol by 19%. At 12 months, NA significantly reduced carotid wall area compared with placebo (adjusted treatment difference: -1.64 mm(2) [95% confidence interval: -3.12 to -0.16]; p = 0.03). Mean change in carotid wall area was -1.1 +/- 2.6 mm(2) for NA versus +1.2 +/- 3.0 mm(2) for placebo. In both the treatment and placebo groups, larger plaques were more prone to changes in size (r = 0.4, p = 0.04 for placebo, and r = -0.5, p = 0.02 for NA).Conclusions In statin-treated patients with low HDL-C, high-dose modified- release NA, compared with placebo, significantly reduces carotid atherosclerosis within 12 months. (Oxford Niaspan Study: Effects of Niaspan on Atherosclerosis and Endothelial Function; NCT00232531) (J Am Coll Cardiol 2009;54:1787-94) (c) 2009 by the American College of Cardiology Foundation