title: Influence of the timing of low-dose aspirin on tolerability of prolonged-release nicotinic acid in patients at elevated cardiovascular risk.
abstract: OBJECTIVE
  To investigate the effect of low-dose aspirin administered in the morning or evening on the rate of discontinuation of prolonged-release nicotinic acid (Niaspan) due to flushing in patients at elevated cardiovascular risk.
  
  
  METHODS
  This was an observational, non-interventional study in patients at elevated cardiovascular risk due to cardiovascular disease or type 2 diabetes. Patients received prolonged-release nicotinic acid and aspirin under the usual care of their physician for 15 weeks.
  
  
  METHODS
  The main outcome measure was the rate of treatment discontinuation for flushing. Other adverse drug reactions (ADRs) were also recorded. Lipid parameters were also measured.
  
  
  RESULTS
  The patient population included 539 subjects (70% male); 36% had type 2 diabetes, 80% had prior cardiovascular disease, and 37% had a family history of cardiovascular disease. The rate of treatment discontinuation due to flushing did not differ (p = 0.3375) between the morning aspirin group (10.6%) and the evening aspirin group (13.8%). The overall incidence of flushing was 57%. Most flushes were of mild or moderate severity and decreases occurred over time in both frequency and intensity. ADRs unrelated to flushing occurred in 6.6% of the morning aspirin group and 7.4% of the evening aspirin group. HDL-cholesterol increased by +21.3% in the overall population, together with moderate improvements in other lipid parameters.
  
  
  CONCLUSIONS
  Flushing was the most common ADR with prolonged-release nicotinic acid treatment, as expected. The timing of aspirin administration did not influence the rate of treatment discontinuations for flushing. Marked increases in HDL-cholesterol were observed.
authors.affiliation: Department of Pharmacology, Faculty of Medical Sciences of Lisbon, Hospital Curry Cabral, Lisbon, Portugal.
authors.forename: J Delgado
authors.initials: JD
authors.lastname: Alves
authors.forename: E
authors.initials: E
authors.lastname: Steinhagen-Thiessen
authors.forename: R
authors.initials: R
authors.lastname: Darioli
authors.forename: U
authors.initials: U
authors.lastname: Hostalek
authors.forename: A
authors.initials: A
authors.lastname: Vogt