title: Combination of niacin extended-release and simvastatin results in a less atherogenic lipid profile than atorvastatin monotherapy.
abstract: OBJECTIVE
  To compare the effects of combination niacin extended-release + simvastatin (NER/S) versus atorvastatin alone on apolipoproteins and lipid fractions in a post hoc analysis from SUPREME, a study which compared the lipid effects of niacin extended-release + simvastatin and atorvastatin in patients with hyperlipidemia or mixed dyslipidemia.
  
  
  METHODS
  Patients (n = 137) with dyslipidemia (not previously receiving statin therapy or having discontinued any lipid-altering treatment 4-5 weeks prior to the study) received NER/S (1000/40 mg/day for four weeks, then 2000/40 mg/day for eight weeks) or atorvastatin 40 mg/day for 12 weeks. Median percent changes in apolipoprotein (apo) A-1, apo B, and the apo B:A-I ratio, and nuclear magnetic resonance lipoprotein subclasses from baseline to week 12 were compared using the Wilcoxon rank-sum test and Fisher's exact test.
  
  
  RESULTS
  NER/S treatment produced significantly greater percent changes in apo A-I and apo B:A-I, and, at the final visit, apo B < 80 mg/dL was attained by 59% versus 33% of patients, compared with atorvastatin treatment (P = 0.003). NER/S treatment resulted in greater percent reductions in calculated particle numbers for low-density lipoprotein (LDL, 52% versus 43%; P = 0.022), small LDL (55% versus 45%; P = 0.011), very low-density lipoprotein (VLDL) and total chylomicrons (63% versus 39%; P < 0.001), and greater increases in particle size for LDL (2.7% versus 1.0%; P = 0.007) and VLDL (9.3% versus 0.1%; P < 0.001), compared with atorvastatin.
  
  
  CONCLUSIONS
  NER/S treatment significantly improved apo A-I levels and the apo B:A-I ratio, significantly lowered the number of atherogenic LDL particles and VLDL and chylomicron particles, and increased the mean size of LDL and VLDL particles, compared with atorvastatin.
authors.affiliation: Baylor College of Medicine and Methodist Hospital, Houston, Texas, USA.
authors.forename: William
authors.initials: W
authors.lastname: Insull
authors.forename: Peter P
authors.initials: PP
authors.lastname: Toth
authors.forename: H Robert
authors.initials: HR
authors.lastname: Superko
authors.forename: Roopal B
authors.initials: RB
authors.lastname: Thakkar
authors.forename: Scott
authors.initials: S
authors.lastname: Krause
authors.forename: Ping
authors.initials: P
authors.lastname: Jiang
authors.forename: Rhea A
authors.initials: RA
authors.lastname: Parreno
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Padley
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000924:Anticholesteremic Agents / Q000494:pharmacology / Q000627:therapeutic use; D050197:Atherosclerosis / Q000517:prevention & control*; D000069059:Atorvastatin; D003692:Delayed-Action Preparations; D004359:Drug Therapy, Combination; D050171:Dyslipidemias / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D005260:Female; D006538:Heptanoic Acids / Q000494:pharmacology / Q000592:standards / Q000627:therapeutic use*; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications / Q000188:drug therapy; D000960:Hypolipidemic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D008074:Lipoproteins / Q000097:blood / Q000187:drug effects; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D008875:Middle Aged; D009525:Niacin / Q000494:pharmacology / Q000592:standards / Q000627:therapeutic use*; D011758:Pyrroles / Q000494:pharmacology / Q000592:standards / Q000627:therapeutic use*; D019821:Simvastatin / Q000494:pharmacology / Q000592:standards / Q000627:therapeutic use*; D016896:Treatment Outcome; D014481:United States
chemical_list: D000924:Anticholesteremic Agents; D003692:Delayed-Action Preparations; D006538:Heptanoic Acids; D000960:Hypolipidemic Agents; D008074:Lipoproteins; D011758:Pyrroles; D009525:Niacin; D000069059:Atorvastatin; D019821:Simvastatin