Simvastatin and Niacin, Antioxidant Vitamins, or the Combination for the Prevention of Coronary Disease

Patients with coronary disease and low high-density lipoprotein (HDL) cholesterol levels are at risk for coronary events. This study found that a combination of niacin and simvastatin was very effective over a period of three years in reducing the frequency of coronary events and causing a slight re...

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Bibliographic Details
Published in:	The New England journal of medicine Vol. 345; no. 22; pp. 1583 - 1592
Main Authors:	Brown, B. Greg, Zhao, Xue-Qiao, Chait, Alan, Fisher, Lloyd D, Cheung, Marian C, Morse, Josh S, Dowdy, Alice A, Marino, Emily K, Bolson, Edward L, Alaupovic, Petar, Frohlich, Jiri, Serafini, Leny, Huss-Frechette, Ellen, Wang, Shari, DeAngelis, Debbie, Dodek, Arthur, Albers, John J
Format:	Journal Article
Language:	English
Published:	Boston, MA Massachusetts Medical Society 29-11-2001
Subjects:	alpha-Tocopherol - therapeutic use Antioxidants - therapeutic use Apolipoproteins - blood Ascorbic Acid - blood Ascorbic Acid - therapeutic use beta Carotene - blood beta Carotene - therapeutic use Biological and medical sciences Cardiology. Vascular system Cardiovascular disease Cardiovascular Diseases - mortality Cardiovascular Diseases - prevention & control Cholesterol Cholesterol, HDL - blood Cholesterol, LDL - blood Colleges & universities Coronary Angiography Coronary Disease - drug therapy Coronary Disease - mortality Coronary Disease - prevention & control Coronary heart disease Coronary Stenosis - drug therapy Double-Blind Method Drug Interactions Drug Therapy, Combination Female General and cellular metabolism. Vitamins Heart Heart attacks Humans Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use Hypolipidemic Agents - adverse effects Hypolipidemic Agents - therapeutic use Lipids - blood Male Medical sciences Middle Aged Niacin - adverse effects Niacin - therapeutic use Pharmacology. Drug treatments Selenium - therapeutic use Simvastatin - therapeutic use Vitamin E - blood Canada Human Drug combination Treatment efficiency Simvastatin Nicotinic acid Vitamin Cardiovascular disease Statin derivative Antioxidant Coronary heart disease Pyridine derivatives Prevention Chemotherapy Treatment Follow up study Adult Comparative study
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Summary:	Patients with coronary disease and low high-density lipoprotein (HDL) cholesterol levels are at risk for coronary events. This study found that a combination of niacin and simvastatin was very effective over a period of three years in reducing the frequency of coronary events and causing a slight regression of coronary lesions, as measured by angiography. By contrast, antioxidant vitamins had no benefit, and the addition of antioxidant vitamins to niacin and simvastatin attenuated their beneficial effect. The combination of niacin and simvastatin had important clinical benefits in patients with coronary disease and low HDL levels. By contrast, antioxidant vitamins had no benefit. On the basis of epidemiologic data, it has been predicted 1 , 2 that each 1 percent reduction in the level of low-density lipoprotein (LDL) cholesterol results in a reduction of 1.0 to 1.5 percent in the risk of major cardiovascular events. In trials of LDL-lowering strategies, a reduction of 12 to 38 percent in the LDL level has resulted in a relative reduction in risk of 19 to 35 percent. 3 , 4 Similarly, in an insightful epidemiologic analysis 5 of risk related to high-density lipoprotein (HDL) cholesterol, an increment of 1 mg per deciliter (0.03 mmol per liter or about 2 to 3 . . .
ISSN:	0028-4793 1533-4406
DOI:	10.1056/NEJMoa011090