Rosuvastatin Alone or With Extended‐Release Niacin: A New Therapeutic Option for Patients With Combined Hyperlipidemia

Combination therapy with a statin and niacin may provide optimal therapy for patients with combined hyperlipidemia and low levels of highdensity lipoprotein (HDL) cholesterol. The authors assessed the efficacy and safety of rosuvastatin monotherapy, extended‐release (ER) niacin monotherapy, or rosuvastatin and ER niacin combined therapy in patients with atherogenic dyslipidemia. In a 24‐week, open‐label, multicenter trial, men and women aged ≥18 years with fasting levels of total cholesterol ≥200 mg/dL, HDL cholesterol ≤45 mg/dL, triglycerides 200–800 mg/dL, and apolipoprotein B ≥110 mg/dL were randomly assigned to one of four treatment groups: rosuvastatin 10–40 mg, ER niacin 0.5–2 g, rosuvastatin 40 mg plus ER niacin 0.5–1 g, or rosuvastatin 10 mg plus ER niacin 0.5–2 g. Daily doses of rosuvastatin 40 mg monotherapy reduced low‐density lipoprotein (LDL) cholesterol and non‐HDL cholesterol levels significantly more than did either ER niacin 2 g monotherapy or rosuvastatin 10 mg combined with ER niacin 2 g. Addition of ER niacin 1 g to rosuvastatin 40 mg did not further reduce total or non‐HDL cholesterol. Triglyceride reductions were similar among the four treatment groups. ER niacin mono‐ and combined therapy produced significantly greater rises in HDL cholesterol and apolipoprotein A‐1 than did rosuvastatin monotherapy. Rosuvastatin monotherapy was better tolerated than ER niacin taken either alone or with rosuvastatin. In this study, rosuvastatin very effectively improved the three major lipoproteinlipid abnormalities of combined hyperlipidemia.