Atherosclerotic progression was slowed; the rate of cardiac events dropped by 40%. The combination of simvastatin plus niacin is particularly effective at preventing atherosclerotic progression and clinical events in patients with the metabolic syndrome, Dr. Xue-Qiao Zhao reported at the annual meeting of the American Academy of Cardiology.
She presented findings from the HDL Atherosclerosis Treatment Study (HATS) underscoring the high event rate associated with metabolic syndrome.
In light of the markedly increased cardiovascular risk the syndrome entails, a more aggressive two-drug approach is warranted, according to Dr. Zhao of the University of Washington, Seattle.
HATS was a double-blind, randomized, placebo-controlled, angiographic study that was funded by the National Insitutes of Health. It included 69 coronary artery disease patients with the metabolic syndrome; 32 of them were randomized to receive 10-20 mg/day of simvastatin plus 2-4 g/day of niacin. During 36 months of follow-up, they had an 18% incidence of clinical events, defined as acute MI, stroke, need for revascularization, or death due to coronary artery disease. The 37 placebo-treated patients with the metabolic syndrome had a 30% event rate. Of the 83 patients who had coronary artery disease and did not meet criteria for metabolic syndrome, the event rate was 2% in those on simvastatin-niacin and 14% in those on placebo.
The simvastatin-niacin combination achieved a 40% reduction in those with the metabolic syndrome and an 86% reduction in major clinical events in metabolic syndrome–negative patients.
The quantitative coronary angiography findings in HATS underscored the aggressive atherosclerotic process seen with the metabolic syndrome. Patients on placebo displayed a mean 4.1% increase in their maximal stenosis during 36 months of follow-up, compared with a 0.4% increase in those on simvastatin-niacin.
In contrast, patients who did not have the metabolic syndrome and received placebo had a 1.4% increase in their mean maximal percent stenosis, compared with a 0.1% increase in those on dual-agent therapy, Dr. Zhao noted.