5 Steps to prevent Heart Disease

Wednesday, May 25, 2016

Niacin not dead at NLA Master's Course in NOLA 5/16

LDLc was reduced in Niacin trials and if given more time may have improved RRR after seven years as with Zetia (IMPROVE-it)

"By contrast, in the AIM-HIGH trial,8 adding niacin to effective LDL cholesterol–lowering therapy reduced the LDL cholesterol level by only 5 mg per deciliter"
NEJM ref

"On the basis of meta-analyses of statin trials, the reduction of 10 mg per deciliter in the LDL cholesterol level in HPS2-THRIVE would have been expected to produce a 5 to 6% proportional reduction in the risk of major vascular events.1 There is no similar evidence from randomized trials regarding the effects of raising the HDL cholesterol level, but if the inverse association with vascular disease risk in observational studies is causal (which has been questioned)18 and half of it is reversible within a few years (as with LDL cholesterol–lowering therapy1) then the increase of 6 mg per deciliter in the HDL cholesterol level observed in HPS2-THRIVE might have been associated with a reduction in the risk of major vascular events of 4 to 5%.2
Consequently, the combined changes in the lipid levels would have been expected to reduce the risk of major vascular events by approximately 10%, which is slightly larger than the observed result (although still statistically compatible with it)."
NEJM ref

At the Master's conference both Dr. Bays and Dr. Jacobson showed the LDLc results of HPS2 Thrive 

That slide was worth the $750 the course cost me. 

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