title: Effects of high-dose modified-release nicotinic acid on atherosclerosis and vascular function: a randomized, placebo-controlled, magnetic resonance imaging study.
abstract: OBJECTIVE
  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).
authors.affiliation: Department of Cardiovascular Medicine, University of Oxford and Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Oxford, United Kingdom.
authors.forename: Justin M S
authors.initials: JM
authors.lastname: Lee
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Robson
authors.forename: Ly-Mee
authors.initials: LM
authors.lastname: Yu
authors.forename: Cheerag C
authors.initials: CC
authors.lastname: Shirodaria
authors.forename: Colin
authors.initials: C
authors.lastname: Cunnington
authors.forename: Ilias
authors.initials: I
authors.lastname: Kylintireas
authors.forename: Janet E
authors.initials: JE
authors.lastname: Digby
authors.forename: Thomas
authors.initials: T
authors.lastname: Bannister
authors.forename: Ashok
authors.initials: A
authors.lastname: Handa
authors.forename: Frank
authors.initials: F
authors.lastname: Wiesmann
authors.forename: Paul N
authors.initials: PN
authors.lastname: Durrington
authors.forename: Keith M
authors.initials: KM
authors.lastname: Channon
authors.forename: Stefan
authors.initials: S
authors.lastname: Neubauer
authors.forename: Robin P
authors.initials: RP
authors.lastname: Choudhury
mesh_terms: D000368:Aged; D002340:Carotid Artery Diseases / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology*; D008076:Cholesterol, HDL / Q000097:blood / Q000187:drug effects; D008078:Cholesterol, LDL / Q000097:blood / Q000187:drug effects; D015986:Confounding Factors, Epidemiologic; D003692:Delayed-Action Preparations; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D000960:Hypolipidemic Agents / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009525:Niacin / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome; D014280:Triglycerides / Q000097:blood; D017539:Tunica Intima / Q000187:drug effects / Q000473:pathology / Q000503:physiopathology; D017540:Tunica Media / Q000187:drug effects / Q000473:pathology / Q000503:physiopathology
chemical_list: D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D003692:Delayed-Action Preparations; D000960:Hypolipidemic Agents; D014280:Triglycerides; D009525:Niacin