Taylor Allen J, Zhu Daming, Sullenberger Lance E, Lee Hyun J, Lee Jeannie K, Grace Karen A
Cardiology Service, Walter Reed Army Medical Center, 6900 Georgia Avenue, NW, Building 2, Room 4A34, Washington, DC 20307-5001, USA.
Vasc Health Risk Manag. 2007;3(1):159-64.
We previously reported in a placebo-controlled study that extended-release niacin slowed the progression of carotid atherosclerosis when added to statin monotherapy. This analysis examines the relationship between glycemic status and the effects of niacin on common carotid intima-media thickness (CIMT) and HDL cholesterol.
Post-hoc, subgroup analysis of ARBITER 2, a randomized, placebo-controlled trial of once-daily extended-release niacin (1000 mg) added to background statin therapy in 167 patients (mean age 67 years) with known coronary heart disease. The primary analysis was a comparison of the primary endpoint, the change in CIMT, between participants with either normal glycemic status, diabetes mellitus (DM) or the metabolic syndrome (MS).
Baseline cardiovascular risk variables were significantly worse in those with abnormal glycemic status, particularly among subjects with MS. Niacin increased HDL-C to a similar degree (approximately 20%) across normals, DM and MS. Placebo-treated patients had the greatest CIMT progression, regardless of glycemic status. The lowest progression rate was observed in niacin treated patients with normal glycemic status. Among all niacin treated subjects, there was a significant linear relationship between change in CIMT and change in HDL-C (r = -0.16; p = 0.05), which was of similar magnitude in subgroups with normal glycemic status (r = -0.23; p = 0.08) and DM (r = -0.22; p = 0.17). In those with MS, there was no relationship between changes in HDL and CIMT, (r = 0.11; p = 0.44), whereas blood glucose was positive correlated to change in CIMT (r = 0.30; p = 0.04). In multivariable linear models controlling for MS characteristics and blood glucose changes, only the change in HDL independently predicted change in CIMT.
During niacin treatment, increases in HDL-C are related to changes in CIMT in the setting of both normal glycemic status and diabetes mellitus.
我们之前在一项安慰剂对照研究中报告称，在他汀类单药治疗基础上加用缓释烟酸可减缓颈动脉粥样硬化的进展。本分析旨在研究血糖状态与烟酸对颈总动脉内膜中层厚度（CIMT）及高密度脂蛋白胆固醇（HDL胆固醇）影响之间的关系。
对ARBITER 2进行事后亚组分析，这是一项随机、安慰剂对照试验，对167例（平均年龄67岁）已知冠心病患者在背景他汀类治疗基础上加用每日一次的缓释烟酸（1000毫克）。主要分析是比较血糖状态正常、患有糖尿病（DM）或代谢综合征（MS）的参与者之间的主要终点即CIMT的变化。
血糖状态异常者的基线心血管风险变量明显更差，尤其是在患有MS的受试者中。在血糖正常者、糖尿病患者和代谢综合征患者中，烟酸使HDL-C升高的程度相似（约20%）。无论血糖状态如何，接受安慰剂治疗的患者CIMT进展最大。在血糖状态正常的烟酸治疗患者中观察到最低的进展率。在所有接受烟酸治疗的受试者中，CIMT变化与HDL-C变化之间存在显著的线性关系（r = -0.16；p = 0.05），在血糖状态正常的亚组（r = -0.23；p = 0.08）和糖尿病亚组（r = -0.22；p = 0.17）中幅度相似。在患有MS的患者中，HDL变化与CIMT之间无关系（r = 0.11；p = 0.44），而血糖与CIMT变化呈正相关（r = 0.30；p = 0.04）。在控制MS特征和血糖变化的多变量线性模型中，只有HDL变化独立预测CIMT变化。
在烟酸治疗期间，在血糖状态正常和糖尿病情况下，HDL-C升高均与CIMT变化有关。
