An open-label comparison of the effects of simvastatin and niacin alone and combined on the lipid profile and lipoprotein (a) level in an Indian population with dyslipidemia

Abstract

Background:

Patients with dyslipidemia often require the use of >1 lipid-altering agent to achieve the target levels recommended by the National Cholesterol Education Program Adult Treatment Panel III.

Objective:

The aim of this study was to compare the effects of simvastatin and niacin alone and combined on the lipid profile and lipoprotein (a) (Lp[a]) level in an Indian population with dyslipidemia.

Methods:

This 12-week, open-label, nonrandomized study was conducted at the Departments of Pharmacology and Medicine, Government Medical College, Amritsar (Punjab), India. Patients aged 30 to 70 years with dyslipidemia were eligible. Patients were assigned to 1 of 3 treatment groups. Group 1 received simvastatin 20 mg/d for 12 weeks. Group 2 received niacin at doses of 375 mg/d for 1 week, 500 mg/d for 1 week, and 500 mg BID for 10 weeks. Group 3 received simvastatin 10 mg/d plus niacin (375 mg for 1 week and 500 mg for 11 weeks). The lipid profile (low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C], total cholesterol [TC], and triglycerides [TG]) and Lp(a) were measured before the start of therapy and at 6 and 12 weeks of treatment. Percentage changes from baseline were calculated. Adverse effects (AEs) were recorded at weeks 6 and 12 and through spontaneous reporting.

Results:

Ninety patients were enrolled (50 men, 40 women; 30 patients per treatment group). In group 1, the mean (SD) percentage decrease in LDL-C level at 12 weeks was 42.79% (16.29%) (P < 0.05), but no significant change was seen in group 2 or 3. The mean (SD) percentage increases in HDL-C level were 18.43% (13.28%) and 20.82% (17.57%) in groups 2 and 3, respectively (both, P < 0.05), but no significant change was seen in group 1. TC levels decreased by a mean (SD) of 32.97% (13.66%) in group 1 (P < 0.05), but no significant change was seen in group 2 or 3. TG and Lp(a) levels did not change significantly in any of the 3 treatment groups. Flushing, myalgia, and dyspepsia were the most common AEs in patients receiving niacin.

Conclusions:

In this study in Indian patients with dyslipidemia, simvastatin-niacin combination therapy was associated with greater changes in lipid profile compared with either agent used alone. Niacin was also associated with greater changes in Lp(a) levels. AEs were less prevalent with combination therapy than with niacin alone.Key words: dyslipidemia, simvastatin, niacin, combination therapy     

Popliteal Venous Aneurysm as a Rare Finding: Management and Therapy Presented in a Case Report

Aneurysms of the popliteal vein without symptoms are a rare clinical finding. Most patients presented with symptoms of thromboembolism. Because of this nobody knows the exact incidence rate of this occurrence. We describe the case a 49-year-old female who presented with popliteal fossa pain. A popliteal venous aneurysm was detected by ultrasound and has now been observed for 42 months without complications, therapy, and symptoms. Literature on the subject, mostly case reports, is rare and the treatments used differed greatly. Most proposalstry to treat asymptomatic patients suffering from saccular aneurysm with parietal thrombi and symptomatic patients are treated by medical or better surgical intervention. The remainder of asymptomatic patients can be kept under observation by means of color Doppler and duplex sonography.     

Cerebellar abscess

Fourteen patients with cerebellar abscesses, of a total of 116 brain abscesses treated at our clinic between 1987 and 1992, were analysed retrospectively. Of 14 cases, 11 were male, 3 were female. The youngest of the cases was 7, while the oldest was 58, and average age was 32.4. Five patients were comatose on admission. Mastoiditis in 6 patients, otitis in 3 patients and pulmonary infection in 1 patient appeared to be the primary foci of infection. In 4 cases no primary infective focus was determined. The periods between the commencement of symptoms and the time of admission to the hospital were as follows: 0–2 weeks in 2 cases, 3–4 weeks in 5 cases and 4–8 weeks in 7 cases. The primary complaints on admission were headache, unconsciousness and unsteadiness. The most frequent findings were cerebellar ataxia, nystagmus and unconsciousness. The lesions in patients were established by computerized tomography. Drainage through a single burr hole was performed in all patients. Samples were taken for culture from all of the cases and microorganisms were isolated from 8 but nothing was grown in the 6 patients. The mortality was 21.4% in this series.