Two-pronged attack of benefit in CV risk reduction
Clinicians have exhausted the lipid-lowering potential of statins and should now turn to combination therapies in an effort to reduce cardiovascular (CV) risk still further.
UK specialists were commenting on data last week, from the American
Heart Association’s scientific congress in Dallas, Texas, suggesting
that adding slow-release nicotinic acid to a statin increases high-density
lipoprotein (HDL) cholesterol levels and may reverse the effects of atherosclerosis.
Tony Wierzbicki, consultant chemical pathologist, Guy’s and St
Thomas’ Hospitals, London, said: “We are lowering low-density
lipoprotein (LDL) cholesterol as much as we can with statins. It’s
time to take a step further and do what we can to raise HDL-cholesterol.”
Data from a 12-month study involving 130 patients showed that when treatment
with extended-release nicotinic acid is added to simvastatin HDL cholesterol
values are increased (from 1.0mmol/L to 1.2mmol/L) and there is regression
of atherosclerotic damage, as measured by carotid intima media thickness.
The study is a prelude to a larger randomised controlled trial involving 3,300
patients. However, this is not due to report until 2010. Richard Hobbs, head
of primary care and general practice, University of Birmingham, commented: “Although
there has been a remarkable reduction in CV mortality in the UK over the past
five years or so, prescribers are increasingly reluctant to push the statin dose
ever higher.”
Until guidelines are updated, Professor Hobbs advised that a two-pronged attack
on CV risk may be the answer. “This study shows that in patients whose
LDL-cholesterol levels have already been well-controlled with a statin, we can
reduce CV risk even further.” |
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