| OBJECTIVE: To determine the efficacy and tolerability of the addition
of low-dose niacin (1.5 g/d) in a diabetic hypercholesterolemic
population who were unable to attain desired lipid control with low-
dose (20 mg) pravastatin monotherapy. RESEARCH DESIGN AND METHODS:
This was a prospective, open-label study conducted over a 14-week
period. Twenty-three diabetic patients with low-density lipoprotein
(LDL) cholesterol concentrations of at least 150 mg/dL after dietary
therapy were recruited from the outpatient diabetes clinic of a
university teaching hospital. After 4 weeks of dietary stabilization
and baseline determination of the lipid profile and glycemic control,
patients received pravastatin 20 mg once daily for 4 weeks.
Laboratory parameters were reassessed and niacin was added to the
regimen in qualifying patients. Over 2 weeks, patients' regimens were
titrated to a maximal dosage of 500 mg tid. Patients continued to
receive the combination regimen for 4 weeks and were reassessed.
MEASUREMENTS AND MAIN RESULTS: Sixteen patients (14 non-insulin-
dependent diabetes mellitus, 2 insulin-dependent diabetes mellitus)
completed the study. Mean fasting blood sugar and fructosamine
concentrations were unchanged throughout the study. Five patients
required minor alterations (3 increased, 2 decreased) in their
hypoglycemic regimens during the study. The addition of low-dose
niacin to pravastatin therapy resulted in a significant lowering of
LDL cholesterol compared with pravastatin monotherapy. CONCLUSIONS:
Low-dose niacin is a promising addition to hydroxymethylglutaryl-
coenzyme A reductase inhibitor therapy in the treatment of
hypercholesterolemia in patients with diabetes mellitus.
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