[Use of prolonged-release nicotinic acid in patients treated with statins as a secondary prevention and a persistently low HDL-cholesterol level in France].
HDL-c is a potent predictor of cardiovascular risk in all epidemiologic studies, especially as secondary prevention, regardless of LDL-c level obtained on statin treatment. The objective of this longitudinal observational study was to investigate the effects of prolonged-release nicotinic acid in high cardiovascular risk patients on statin treatment and with low HDL-c.


METHODS
The selected patients of both genders, aged over 18 years patients showed primary hypercholesterolemia or mixed hyperlipidemia, received statin treatment as secondary prevention and had a HDL-c level <or=0.40 g/l. Treatment with prolonged-release nicotinic acid was initiated according to the approved dosing regimen.


RESULTS
The analysis was performed in 368 patients selected by 224 cardiologists. Mean follow-up time was 103 days with a daily dose of prolonged-release nicotinic acid of 1,076 mg. Mean LDL-c changed from 1.08 to 1g/l (p<0.001), mean HDL-c from 0.34 g to 0.42 g/l (+23%, p<0.001) and triglycerides from 1.81 to 1.53 g/l (p<0.001). Eighty nine percent of treatment discontinuations (n=107) were due to side effects, almost half of them being flushes (46.3%). The incidence of flushes was significantly more rapidly reduced in patients taking aspirin (p<0.001).


CONCLUSIONS
Expected efficacy results were obtained, especially with a very significant increase in HDL-c. The adjunction of prolonged-release nicotinic acid in high risk patients on statin treatment as secondary prevention and with low HDL-c constitutes an interesting strategy.
Paillard
F
F
Centre de prévention cardiovasculaire, hôpital Pontchaillou, 2, rue Henri-le-Guilloux, 35033 Rennes cedex, France.
Mosnier
M
M
D008076:Cholesterol, HDL / Q000097:blood*; D003692:Delayed-Action Preparations; D005260:Female; D005602:France; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D006949:Hyperlipidemias / Q000188:drug therapy*; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009525:Niacin / Q000627:therapeutic use*
D008076:Cholesterol, HDL; D003692:Delayed-Action Preparations; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000960:Hypolipidemic Agents; D009525:Niacin