In the study presented today at the American Heart Association Scientific Sessions in Orlando, Florida today, The Effect of Extended-release Niacin or Ezetimibe Added to Chronic Statin Therapy On Carotid Intima Media Thickness (ARBITER 6-HALTS), study found that:
- Adding the cholesterol drug niacin to a statin improved HDL ("good") cholesterol levels and significantly reduced carotid arterial plaque buildup measured with ultrasound within 8 months, with further improvement seen at the end of the study (14 months).
- An alternative approach, adding ezetimibe to a statin, lowered LDL ("bad") cholesterol to a greater extent, but did not raise HDL. With it, there was no overall effect on arterial build up in the neck arteries as observed on carotid ultrasound.
- The incidence of major cardiovascular events such as fatal and non-fatal heart attack was higher in the ezetimibe group as compared to the niacin group (5 percent vs. 1 percent).
ARBITER-HALTS was a relatively small prospective, randomized, parallel group, open- label, blinded endpoint study conducted at Walter Reed Army Medical Center in Washington, D.C., and Washington Adventist Hospital. It only included 363 adults (80 percent male, average age 68 years) with or at high risk for atherosclerotic cardiovascular disease. All participants were on cholesterol-lowering statin drugs, and their LDL cholesterol was at the treatment goal of under 100 milligrams per deciliter (mg/dL) of blood. Their HDL cholesterol was lower than 50 mg/dL for men and 55 mg/dL for women. Patients were randomly assigned to receive either niacin or ezetimibe in addition to their usual statin. The primary endpoint was the change in the wall thickness of the carotid artery in the neck between the two groups of patients.
In the niacin group. HDL cholesterol rose from 42 mg/dL to 50 mg/dL and there was a significant regression in artery wall thickness. In the ezetimibe group, average LDL cholesterol levels dropped from 83 mg/dL to 66 mg/dL; however no overall change was found in average artery wall thickness.