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AIM-HIGH: post hoc analysis suggests benefit in atherogenic dyslipidaemia

The AIM-HIGH (Atherothrombosis Intervention in Metabolic Syndrome with Low HDL/High Triglycerides and Impact on Global Health Outcomes) trial did not show any incremental clinical benefit of extended-release niacin in 3414 statin-treated patients with cardiovascular disease and low baseline levels of high-density lipoprotein cholesterol (HDL-C). However, the most recent analysis from this group suggests that niacin may confer benefit in patients with atherogenic dyslipidaemia by reducing remnant lipoprotein cholesterol and increasing HDL2-C.
In this new analysis, investigators evaluated the relationship between niacin treatment, lipoproteins and their subfractions, and cardiovascular outcomes in 2457 patients in the AIM-study at baseline and after 1 year of treatment. Overall, they showed that apoliprotein(apo) B-containing lipoproteins and their subfractions decreased and HDL-C and its subfractions increased more in patients treated with niacin than placebo. Among the subgroup with atherogenic dyslipidaemia (elevated triglycerides and low HDLC) treated with niacin, the data suggested that a reduction in levels of remnant lipoprotein cholesterol (very low-density lipoprotein cholesterol and its subfractions and total remnant lipoproteins) at 1 year, and an increase of HDL subclass HDL2-C were associated with reduced cardiovascular risk. The AIM-HIGH investigators make the case, however, that this post hoc analysis is solely hypothesis-generating and requires further evaluation.
Relationship between lipoprotein subfraction cholesterol and residual risk for cardiovascular outcomes: A post hoc analysis of the AIM-HIGH trial.

Toth PP, Jones SR, Slee A et al.