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

• 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
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJMoa011090

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 . . .