Niacin, a form of vitamin B, is superior to ezetimibe, or Zetia, for boosting good cholesterol, according to a study published online November 15, 2009 in The New England Journal of Medicine. Although Zetia is effective at reducing LDL, otherwise known as ‘bad cholesterol’, it seems that niacin is the better drug for high-risk patients who need to add a second cholesterol-lowering medication to their statin therapy.

According to the Arterial Biology for the Investigation of the Treatment Effects of Reducing Cholesterol 6: HDL and LDL Treatment Strategies in Atherosclerosis (ARBITER 6-HALTS) study, extended-release niacin results in significant regression of plaque build-up on the walls of arteries when added to statin therapy, while Zetia does not. While Zetia reduced LDL by 20 percent in patients who already relatively low LDL cholesterol levels, Zetia therapy also led to a slight worsening of arterial plaque build-up. In addition, patients taking Zetia were more likely to have heart attacks or stroke and were also more like to die from heart disease.

Dr. Anthony DeMaria, editor in chief of the Journal of the American College of Cardiology, indicated that the ARBITER 6-HALTS findings will put Zetia at the bottom of the list of cholesterol-lowering medications that doctors will be using.

Patients should be aware that the niacin used in this study is not the kind that can be found in health food stores or drug stores. This niacin is a prescription medication that has a special extended-release formulation that cuts down on side effects such as flushing. In 2008, 9 million patients were on Zetia, as compared to only 2.5 million who were on niacin. Switching Zetia patients to niacin could potentially result in a big savings in health care costs, as niacin is a relatively inexpensive drug.

Source:

www.nejm.org, published online 15 November 2009.