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Efficacy and Tolerability of Low-dose Simvastatin and Niacin, Alone and in Combination, in Patients With Combined Hyperlipidemia: A Prospective Trial

Medical Research Laboratories, Cincinnati, Ohio; Chicago Center for Clinical Research, Chicago, Illinois; University of Kansas Medical Center, Kansas City, Kansas; University of Minnesota Medical Center, Minneapolis, Minnesota; University of Miami Medical Center, Miami, Florida; Oregon Health Sciences University, Portland, Oregon; University of Washington Medical Center, Seattle. Washington; George Washington University Medical Center, Washington. D.C.; University of California at San Francisco. San Francisco. California; The Christ Hospital Cardiovascular Research Center, Cincinnati, Ohio; and Merck Research Laboratories, Rahway, New Jersey.

Michael H. Davidson, MD

Medical Research Laboratories, Cincinnati, Ohio; Chicago Center for Clinical Research, Chicago, Illinois; University of Kansas Medical Center, Kansas City, Kansas; University of Minnesota Medical Center, Minneapolis, Minnesota; University of Miami Medical Center, Miami, Florida; Oregon Health Sciences University, Portland, Oregon; University of Washington Medical Center, Seattle. Washington; George Washington University Medical Center, Washington. D.C.; University of California at San Francisco. San Francisco. California; The Christ Hospital Cardiovascular Research Center, Cincinnati, Ohio; and Merck Research Laboratories, Rahway, New Jersey.

Carlos A. Dujovne, MD

Medical Research Laboratories, Cincinnati, Ohio; Chicago Center for Clinical Research, Chicago, Illinois; University of Kansas Medical Center, Kansas City, Kansas; University of Minnesota Medical Center, Minneapolis, Minnesota; University of Miami Medical Center, Miami, Florida; Oregon Health Sciences University, Portland, Oregon; University of Washington Medical Center, Seattle. Washington; George Washington University Medical Center, Washington. D.C.; University of California at San Francisco. San Francisco. California; The Christ Hospital Cardiovascular Research Center, Cincinnati, Ohio; and Merck Research Laboratories, Rahway, New Jersey.

Donald B. Hunninghake, MD

Medical Research Laboratories, Cincinnati, Ohio; Chicago Center for Clinical Research, Chicago, Illinois; University of Kansas Medical Center, Kansas City, Kansas; University of Minnesota Medical Center, Minneapolis, Minnesota; University of Miami Medical Center, Miami, Florida; Oregon Health Sciences University, Portland, Oregon; University of Washington Medical Center, Seattle. Washington; George Washington University Medical Center, Washington. D.C.; University of California at San Francisco. San Francisco. California; The Christ Hospital Cardiovascular Research Center, Cincinnati, Ohio; and Merck Research Laboratories, Rahway, New Jersey.

Ronald B. Goldberg, MD

Medical Research Laboratories, Cincinnati, Ohio; Chicago Center for Clinical Research, Chicago, Illinois; University of Kansas Medical Center, Kansas City, Kansas; University of Minnesota Medical Center, Minneapolis, Minnesota; University of Miami Medical Center, Miami, Florida; Oregon Health Sciences University, Portland, Oregon; University of Washington Medical Center, Seattle. Washington; George Washington University Medical Center, Washington. D.C.; University of California at San Francisco. San Francisco. California; The Christ Hospital Cardiovascular Research Center, Cincinnati, Ohio; and Merck Research Laboratories, Rahway, New Jersey.

D. Roger Illingworth, MD, PhD

Medical Research Laboratories, Cincinnati, Ohio; Chicago Center for Clinical Research, Chicago, Illinois; University of Kansas Medical Center, Kansas City, Kansas; University of Minnesota Medical Center, Minneapolis, Minnesota; University of Miami Medical Center, Miami, Florida; Oregon Health Sciences University, Portland, Oregon; University of Washington Medical Center, Seattle. Washington; George Washington University Medical Center, Washington. D.C.; University of California at San Francisco. San Francisco. California; The Christ Hospital Cardiovascular Research Center, Cincinnati, Ohio; and Merck Research Laboratories, Rahway, New Jersey.

Robert H. Knopp, MD

Medical Research Laboratories, Cincinnati, Ohio; Chicago Center for Clinical Research, Chicago, Illinois; University of Kansas Medical Center, Kansas City, Kansas; University of Minnesota Medical Center, Minneapolis, Minnesota; University of Miami Medical Center, Miami, Florida; Oregon Health Sciences University, Portland, Oregon; University of Washington Medical Center, Seattle. Washington; George Washington University Medical Center, Washington. D.C.; University of California at San Francisco. San Francisco. California; The Christ Hospital Cardiovascular Research Center, Cincinnati, Ohio; and Merck Research Laboratories, Rahway, New Jersey.

Valery T. Miller, MD

Medical Research Laboratories, Cincinnati, Ohio; Chicago Center for Clinical Research, Chicago, Illinois; University of Kansas Medical Center, Kansas City, Kansas; University of Minnesota Medical Center, Minneapolis, Minnesota; University of Miami Medical Center, Miami, Florida; Oregon Health Sciences University, Portland, Oregon; University of Washington Medical Center, Seattle. Washington; George Washington University Medical Center, Washington. D.C.; University of California at San Francisco. San Francisco. California; The Christ Hospital Cardiovascular Research Center, Cincinnati, Ohio; and Merck Research Laboratories, Rahway, New Jersey.

Philip Frost, MD

Medical Research Laboratories, Cincinnati, Ohio; Chicago Center for Clinical Research, Chicago, Illinois; University of Kansas Medical Center, Kansas City, Kansas; University of Minnesota Medical Center, Minneapolis, Minnesota; University of Miami Medical Center, Miami, Florida; Oregon Health Sciences University, Portland, Oregon; University of Washington Medical Center, Seattle. Washington; George Washington University Medical Center, Washington. D.C.; University of California at San Francisco. San Francisco. California; The Christ Hospital Cardiovascular Research Center, Cincinnati, Ohio; and Merck Research Laboratories, Rahway, New Jersey.

Jonathan L. Isaacsohn, MD

Medical Research Laboratories, Cincinnati, Ohio; Chicago Center for Clinical Research, Chicago, Illinois; University of Kansas Medical Center, Kansas City, Kansas; University of Minnesota Medical Center, Minneapolis, Minnesota; University of Miami Medical Center, Miami, Florida; Oregon Health Sciences University, Portland, Oregon; University of Washington Medical Center, Seattle. Washington; George Washington University Medical Center, Washington. D.C.; University of California at San Francisco. San Francisco. California; The Christ Hospital Cardiovascular Research Center, Cincinnati, Ohio; and Merck Research Laboratories, Rahway, New Jersey.

Yale B. Mitchel, MD

Medical Research Laboratories, Cincinnati, Ohio; Chicago Center for Clinical Research, Chicago, Illinois; University of Kansas Medical Center, Kansas City, Kansas; University of Minnesota Medical Center, Minneapolis, Minnesota; University of Miami Medical Center, Miami, Florida; Oregon Health Sciences University, Portland, Oregon; University of Washington Medical Center, Seattle. Washington; George Washington University Medical Center, Washington. D.C.; University of California at San Francisco. San Francisco. California; The Christ Hospital Cardiovascular Research Center, Cincinnati, Ohio; and Merck Research Laboratories, Rahway, New Jersey.

Michael R. Melino, PhD

Medical Research Laboratories, Cincinnati, Ohio; Chicago Center for Clinical Research, Chicago, Illinois; University of Kansas Medical Center, Kansas City, Kansas; University of Minnesota Medical Center, Minneapolis, Minnesota; University of Miami Medical Center, Miami, Florida; Oregon Health Sciences University, Portland, Oregon; University of Washington Medical Center, Seattle. Washington; George Washington University Medical Center, Washington. D.C.; University of California at San Francisco. San Francisco. California; The Christ Hospital Cardiovascular Research Center, Cincinnati, Ohio; and Merck Research Laboratories, Rahway, New Jersey.

Deborah Shapiro, DPH

Medical Research Laboratories, Cincinnati, Ohio; Chicago Center for Clinical Research, Chicago, Illinois; University of Kansas Medical Center, Kansas City, Kansas; University of Minnesota Medical Center, Minneapolis, Minnesota; University of Miami Medical Center, Miami, Florida; Oregon Health Sciences University, Portland, Oregon; University of Washington Medical Center, Seattle. Washington; George Washington University Medical Center, Washington. D.C.; University of California at San Francisco. San Francisco. California; The Christ Hospital Cardiovascular Research Center, Cincinnati, Ohio; and Merck Research Laboratories, Rahway, New Jersey.

Jonathan A. Tobert, MD, PhD

Medical Research Laboratories, Cincinnati, Ohio; Chicago Center for Clinical Research, Chicago, Illinois; University of Kansas Medical Center, Kansas City, Kansas; University of Minnesota Medical Center, Minneapolis, Minnesota; University of Miami Medical Center, Miami, Florida; Oregon Health Sciences University, Portland, Oregon; University of Washington Medical Center, Seattle. Washington; George Washington University Medical Center, Washington. D.C.; University of California at San Francisco. San Francisco. California; The Christ Hospital Cardiovascular Research Center, Cincinnati, Ohio; and Merck Research Laboratories, Rahway, New Jersey.

Background: Combination lipid-lowering therapy may be desirable in patients with elevated low-density lipoprotein cholesterol, high triglycerides, and low high-density lipoprotein cholesterol. This study was conducted to determine the lipid-lowering efficacy of the combination of low-dose simvastatin and niacin in patients with combined hyperlipidemia and low high-density lipoprotein cholesterol.

Methods and Results: In this multicenter, prospective, randomized trial, 180 patients with hyper cholesterolemia and hypertriglyceridernia and/or low high-density lipoprotein cholesterol were randomized to combination simvastatin (10 mg/day) and niacin (0.75 g/day) or to either drug alone for 9 weeks. The dose of niacin was doubled (from 0.75 g/day to 1.5 g/day) in both the combination and niacin arms for the remaining 8 weeks. The combination of simvastatin, 10 mg/day, and niacin, 1.5 g/day, reduced total. low-density lipoprotein, and very low-density lipoprotein cholesterol and triglycerides by 248, 29%, 45%, and 31%, respectively, while increasing high-density lipoprotein cholesterol by 31%. The addition of niacin to simvastatin did not enhance the low-density lipoprotein cholesterol-lowering effect of simvastatin; however, the combination was more effective than either monotherapy at raising high-density lipoprotein cholesterol and lowering very low-density lipoprotein cholesterol (P <.05). More patients discontinued treatment because of an adverse event in the niacin (P <.03) and combination groups (P =.06) than the simvastatin group.

Conclusions: Treatment of patients with combined hyperlipidemia and/or low high-density lipoprotein with combination low-dose simvastatin and niacin resulted in large reductions in total, low-density lipoprotein, and very low-density lipoprotein cholesterol and increases in HDL cholesterol. Although the combination was well tolerated in the current trial, its safety needs to be evaluated in larger trials of longer duration.

Key Words: hypercholesterolemia • HMG-CoA-reductase inhibitor

Journal of Cardiovascular Pharmacology and Therapeutics, Vol. 1, No. 2, 107-116 (1996)
DOI: 10.1177/107424849600100204


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