To assess the effects of lipid-lowering drugs and/or antioxidant vitamins on progression or regression of coronary heart disease as measured by quantitative angiography in patients with low high density lipoprotein (HDL) cholesterol.

HDL-Atherosclerosis Treatment Study (HATS) was a randomized, 2 x 2 factorial study wherein 160 patients, both men and women with low HDL cholesterol, with at least one 50% stenotic coronary lesion or three 30% stenotic coronary lesions were enrolled. All the patients were randomized into four groups which were simvastatin (10-20g/day) plus niacin (2-4g/day), antioxidant vitamins (vitamins E, C, A and selenium), simvastatin-niacin plus antioxidants; or placebos. The primary end points were arteriographic evidence of a change in coronary stenosis and the occurrence of a first cardiovascular event (death, myocardial infarction, stroke, or revascularization). Coronary angiograms were done at baseline and at three years to assess the change.

• In the simvastatin-niacin group mean LDL-C was reduced by 42% and mean HDL-C was increased by 26% while levels of LDL-C and HDL-C in the antioxidants and placebo groups remained unaltered.
• The rate of progression of coronary stenoses was lower in the simvastatin-niacin group compared to the other groups.
• Patients receiving simvastatin and niacin sustained lower cardiovascular events.
• Antioxidant vitamins alone had no benefit on progression or on clinical events.

Addition of a drug that increases HDL-C levels to a statin proves to have additional protection over just statin alone.^[1]