Display options
Cite
Vittone F, Chait A, Morse JS, et al. Niacin plus Simvastatin Reduces Coronary Stenosis Progression Among Patients with Metabolic Syndrome Despite a Modest Increase in Insulin Resistance: A Subgroup Analysis of the HDL-Atherosclerosis Treatment Study (HATS). J Clin Lipidol. 2007;1(3):203-210doi: 10.1016/j.jacl.2007.05.003.
Vittone, F., Chait, A., Morse, J. S., Fish, B., Brown, B. G., & Zhao, X. Q. (2007). Niacin plus Simvastatin Reduces Coronary Stenosis Progression Among Patients with Metabolic Syndrome Despite a Modest Increase in Insulin Resistance: A Subgroup Analysis of the HDL-Atherosclerosis Treatment Study (HATS). Journal of clinical lipidology, 1(3), 203-210. https://doi.org/10.1016/j.jacl.2007.05.003
Vittone, Francesca, et al. "Niacin plus Simvastatin Reduces Coronary Stenosis Progression Among Patients with Metabolic Syndrome Despite a Modest Increase in Insulin Resistance: A Subgroup Analysis of the HDL-Atherosclerosis Treatment Study (HATS)." Journal of clinical lipidology vol. 1,3 (2007): 203-210. doi: https://doi.org/10.1016/j.jacl.2007.05.003
Vittone F, Chait A, Morse JS, Fish B, Brown BG, Zhao XQ. Niacin plus Simvastatin Reduces Coronary Stenosis Progression Among Patients with Metabolic Syndrome Despite a Modest Increase in Insulin Resistance: A Subgroup Analysis of the HDL-Atherosclerosis Treatment Study (HATS). J Clin Lipidol. 2007 Jul;1(3):203-210. doi: 10.1016/j.jacl.2007.05.003. PMID: 18591993; PMCID: PMC2157569.
Copy Download .nbib Format: NLM
Share it on

J Clin Lipidol. 2007 Jul;1(3):203-210. doi: 10.1016/j.jacl.2007.05.003.

Niacin plus Simvastatin Reduces Coronary Stenosis Progression Among Patients with Metabolic Syndrome Despite a Modest Increase in Insulin Resistance: A Subgroup Analysis of the HDL-Atherosclerosis Treatment Study (HATS).

Journal of clinical lipidology

Francesca Vittone, Alan Chait, Josh S Morse, Brian Fish, B Greg Brown, Xue-Qiao Zhao

Affiliations

  1. Department of Medicine, Division of Metabolism, Endocrinology, and Nutrition, University of Washington, Seattle, USA.

PMID: 18591993 PMCID: PMC2157569 DOI: 10.1016/j.jacl.2007.05.003

Abstract

BACKGROUND: Metabolic syndrome, insulin resistance and diabetes are associated with an increased risk of cardiovascular disease. Niacin is known to increase insulin resistance, and have adverse effects on blood glucose levels, but to have beneficial effects on plasma lipids and lipoproteins. We therefore aimed to determine whether intensive lipid therapy with a niacin-containing regimen would have a beneficial effect on cardiovascular disease, despite an expected increase in plasma glucose and insulin resistance in subjects with the metabolic syndrome, insulin resistance or abnormal fasting plasma glucose levels. METHODS: The effect of three years' treatment with niacin plus simvastatin (N+S) on both angiographic and clinical outcomes were analyzed in the 160 subjects with coronary artery disease (CAD) and low levels of high density lipoproteins (HDL) from the HDL-Atherosclerosis Treatment Study (HATS). A subgroup analysis was performed on the basis of: (1) the presence or absence of the metabolic syndrome, (2) higher or lower insulin resistance, and (3) the presence or absence of impaired fasting glucose or diabetes (dysglycemia). Individuals classified as having the MS, increased insulin resistance or dysglycemia would be expected to have increased cardiovascular risk. RESULTS: N+S reduced the change in mean proximal percent stenosis (Δ%S) compared to placebo (PL) in subjects with the metabolic syndrome (Δ%Sprox 0.3 vs 3.0, p=0.003) and in the more insulin resistant group of subjects (Δ%Sprox 0.5 vs 2.7, p=0.001), while subjects with dysglycemia (impaired fasting glucose or diabetes) showed a lesser benefit (Δ%Sprox 1 vs 3.2, p=0.13). These changes occurred despite increased in-treatment fasting glucose levels (3%), fasting insulin (19%) and decreased insulin sensitivity (-10%). Overall primary clinical events were reduced by 60% with N+S compared to PL (p=0.02). A similar reduction of the rate of primary events was seen in patients with metabolic syndrome, insulin resistance, and to a lesser extent in patients with dysglycemia in the N+S group compared to PL. CONCLUSIONS: These data indicate that, in CAD patients with low HDL, treating the atherogenic dyslipidemia with a combination of N+S leads to substantial benefits in terms of stenosis progression and clinical events, independently of whether the patient has the metabolic syndrome or is insulin resistant. Over a 3 year period, the beneficial effect of niacin in combination with simvastatin appears to offset the modest adverse effect of niacin on glucose metabolism and insulin resistance in at higher risk patients, as long as careful attention is paid to glycemic control.

References

  1. Circulation. 2004 Sep 7;110(10):1245-50 - PubMed
  2. Arterioscler Thromb Vasc Biol. 2004 Feb;24(2):e13-8 - PubMed
  3. Circulation. 2001 Dec 18;104(25):3046-51 - PubMed
  4. Can J Cardiol. 1998 Apr;14 Suppl A:6A-13A - PubMed
  5. Arch Intern Med. 2002 Jul 22;162(14):1568-76 - PubMed
  6. Lancet. 1998 Sep 12;352(9131):837-53 - PubMed
  7. Diabetes Care. 2005 Sep;28(9):2289-304 - PubMed
  8. Circulation. 2000 Jul 4;102(1):21-7 - PubMed
  9. Circulation. 1995 Oct 1;92(7):1779-85 - PubMed
  10. Curr Atheroscler Rep. 2000 Jan;2(1):36-46 - PubMed
  11. Ann Pharmacother. 2004 Feb;38(2):277-85 - PubMed
  12. JAMA. 2002 Dec 4;288(21):2709-16 - PubMed
  13. N Engl J Med. 2001 Nov 29;345(22):1583-92 - PubMed
  14. Am J Cardiol. 2004 Feb 1;93(3):307-12 - PubMed
  15. JAMA. 2001 May 16;285(19):2486-97 - PubMed
  16. Cardiovasc Diabetol. 2006 Sep 26;5:20 - PubMed
  17. Diabetes Care. 2003 May;26(5):1513-7 - PubMed
  18. Am J Cardiol. 1998 Feb 26;81(4A):18B-25B - PubMed
  19. Am J Cardiol. 2005 Jan 15;95(2):254-7 - PubMed
  20. J Intern Med. 2005 Aug;258(2):94-114 - PubMed
  21. JAMA. 1979 May 11;241(19):2035-8 - PubMed
  22. Am J Cardiol. 2006 Feb 15;97(4):477-9 - PubMed
  23. JAMA. 2001 Mar 28;285(12):1585-91 - PubMed
  24. Lancet. 2005 Oct 8;366(9493):1267-78 - PubMed
  25. Scand J Clin Lab Invest. 1996 Oct;56(6):563-70 - PubMed
  26. Metabolism. 2003 Jun;52(6):699-704 - PubMed
  27. Diabetes Care. 2004 Jun;27(6):1487-95 - PubMed
  28. Diabetes Care. 2006 Jan;29(1):123-30 - PubMed
  29. Circulation. 1999 Feb 16;99(6):736-43 - PubMed
  30. Diabetes. 1988 Dec;37(12):1595-607 - PubMed
  31. JAMA. 2000 Sep 13;284(10):1263-70 - PubMed
  32. Diabetes. 2004 Aug;53(8):2087-94 - PubMed

Publication Types

Grant support