Extended-Release Niacin Outperforms Ezetimibe in Lowering Cardiovascular Risk

In patients with high cardiovascular risk, extended-release niacin is associated with better outcomes than ezetimibe, according to a New England Journal of Medicine study released online.

Researchers randomized over 350 patients on long-term statins to added therapy with either niacin or ezetimibe. The primary endpoint was the difference in change of carotid artery intima–media thickness from baseline to 14 months between groups. After 208 patients had completed the trial, it was stopped when results significantly favored niacin.

Two accompanying editorials bemoan the trial's early end, arguing that all patients studied up to the point of stoppage should have been analyzed, not just those who completed 14 months' therapy. Nonetheless, both support the use of niacin over ezetimibe in high-risk patients, and both point to trials, now under way, that may provide more definitive results. In Journal Watch Cardiology, Dr. Harlan Krumholz says that these results "will not be available for many years. In the meantime, ezetimibe should be a drug of last resort, if it is used at all."