The Great Debate: Niacin vs. Fibrate Part 2

Allen J. Taylor, MD, a professor of medicine, at Georgetown University, discussed the benefits of using niacin in the treatment of high cholesterol in the second part of a debate at the 2010 Cardiometabolic Health Congress.

He began his debate by citing a number of guidelines on treating cardiovascular risks and those for treating diabetes that fail to clearly recommend either niacin or fenofibrate but leave the decision up to the healthcare professionals’ discretion. Half of the US population has a lipid problem, Taylor said, and one in four has low HDL.

“We’re under-treating metabolic syndrome when it comes to lipids,” he said. All can agree that more needs to be done when it comes to treating low HDL cholesterol, he said.

Taylor highlighted the HATS study, which focused on administering patients a statin and niacin versus a placebo group. The results demonstrated that in patients with metabolic syndrome, there was a 90% reduction in quantitative coronary angiography.

In the ARBITER2 study, patients were exposed to niacin and resulted in a 25% increase in HDL levels as well as a regression of atherosclerosis. Likewise, in the ARBITER6 study, the metabolic syndrome patients experienced regression of intimate media thickness with niacin treatment.

In the CORONARY DRUG PROJECT, men with metabolic syndrome had a 68% reduction in cardiovascular events.

Taylor said he feels the data is strongest for recommending Niacin in patients with metabolic syndrome.