Schaefer - Figure 16 - Summary of statins, niacin Text
To summarize the studies with niacin and statins, the Figure shows that the combination of these 2 drugs is actually ideal, because
- statins inhibit cholesterol production, resulting in enhanced fractional clearance of both intestinal and liver LDL particles and, secondarily, a modest effect on lowering the activity of CETP by about 40%; this combination has little effect on HDL cholesterol levels, but on the other hand this therapy does rearrange the spectrum of HDL particle sizes in a favorable direction;
- niacin has a more modest effect on LDL levels and particle spectrum, but it does up-regulate the macrophage ABCA1 transporter and increase apoA-I production, with a concomitant increase in efflux of cholesterol from arterial macrophages and plaques.