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Niacin Superior to Zetia for Lowering LDL Cholesterol


Results of the ARBITER-6 HALTS trial, which compared the LDL-cholesterol-lowering drug Zetia with an extended-released niacin (Niaspan) in reducing plaque accumulation in arteries, clearly show that niacin is superior to Zetia (ezetimibe). The results were presented at the American Heart Association’s annual meeting in Orlando, Florida, and released November 16 online in the New England Journal of Medicine.

Zetia is a cholesterol-lowering drug that is prescribed for millions of Americans along with another class of cholesterol-lowering medications, statins, to reduce low-density lipoprotein (LDL), or “bad” cholesterol levels. Niacin, a B vitamin, raises high-density lipoprotein (HDL), or “good” cholesterol. Patients who have high cholesterol are often prescribed a combination of drugs, typically a statin and another cholesterol-lowering drug, or niacin.

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Although statins (e.g., lovastatin, simvastatin) effectively reduce LDL cholesterol in many patients, others need additional therapy. The ARBITER-6 HALTS study explored raising HDL levels with niacin or attempting to further reduce LDL levels with Zetia, which is a combination of a statin and ezetimibe.

A total of 363 patients who had or who were at high risk for heart disease and who were taking a statin drug were enrolled. The study was designed to test the effect of niacin or Zetia on carotid artery wall thickness. The 14-month study was halted after only 208 patients had completed the full treatment regimen. The researchers found that patients who were taking the extended-release niacin (targeted dose, 2000 mg daily) had less accumulation of plaque and fewer cardiovascular events compared with the patients who were taking Zetia (10 mg daily). Patients who were taking Zetia had more plaque build-up in their carotid artery.

Some experts are raising questions, however. Editorials in the New England Journal of Medicine have asked whether the study comparing Zetia and niacin was halted prematurely and if the patient population was too small to allow researchers to reach any definitive conclusions about niacin. Therefore the debate over whether the combination drug Zetia is superior to niacin for treating high cholesterol appears to continue.

Reuters Nov. 16, 2009
Taylor AJ et al. New England Journal of Medicine, published online Nov. 15, 2009
US News & World Report, Nov. 15, 2009