Effect of Niacin on Carotid Atherosclerosis in Patients at Low-Density Lipoprotein-Cholesterol Goal but High Lipoprotein (a) Level: a 2-Year Follow-Up Study

OBJECTIVE: To examine the effect of niacin on the progression of carotid intima-media thickness (IMT) in patients with high level of lipoprotein (Lp) (a). METHODS: Patients at low-density lipoprotein-cholesterol goal but with Lp (a) >25 mg/dL and mean carotid IMT >0.75 mm were included. Eligible patients were randomized at a 1:2 ratio into one of two groups for 24 months: control or 1,500 mg extended release niacin. The primary study outcomes were the percentage changes in mean and maximal carotid IMT. The percentage change in lipid profiles including Lp (a) was analyzed as a secondary study outcome. RESULTS: Among 96 randomized patients, 31 completed the study (mean age: 65 years; male: 44%). At follow-up, the percentage change in mean carotid IMT was not significantly different between the two groups (−1.4%±15.5% and −1.1%±7.3% in the control and niacin groups, respectively, p=0.95). The percentage change in maximal carotid IMT was also similar in the two groups (0.7%±16.5% and −4.4%±11.6%, respectively, p=0.35). Elevation of high-density lipoprotein-cholesterol tended to be higher in the niacin group (p=0.07), and there was a significant difference in the percentage change in hemoglobin A1c between the two groups (−1.9%±2.2% and 3.3%±6.7%, respectively, p=0.02). Reduction of Lp (a) was greater in the niacin-treated group compared to placebo, but the difference was not statistically significant. CONCLUSION: Treatment with niacin for two years did not inhibit the progression of carotid intima-media thickening in patients with high Lp (a) level. However, this study may have been underpowered to evaluate the primary study outcome.

Chronic Obstructive Pulmonary Disease Increases the Risk of New-onset Atrial Fibrillation and Mortality of Patients with Atrial Fibrillation

BACKGROUND: Although a few previous studies have analyzed the role of reduced lung function in predicting atrial fibrillation (AF), the relationship between the incidence of AF and comorbid chronic obstructive pulmonary disease (COPD) is unclear. We hypothesized that COPD is associated with the occurrence of new-onset AF and clinical outcomes in AF patients. METHODS: We analyzed the development of new-onset AF in 501,668 patients without AF and clinical outcomes in 4,541 patients with AF using Korean National Health Insurance Service-National Sample Cohort (NHIS-NSC). RESULTS: Comorbid COPD was found in 4.8% (11,442 of 501,668) of non-AF patients and 18.6% (820 of 4,541) of AF patients. The incidence of AF in COPD patients was significantly higher compared to non-COPD patients (2.6% vs. 0.6%, p < 0.001) over the follow-up period (45.5±14.9 months). In a multivariate Cox regression analysis, COPD predicted higher risk of AF independently from other risk factors (HR: 1.41, 95% CI: 1.25-1.60, p < 0.001). The allcause mortality of AF patients with COPD was significantly higher in patients who used b-blockers (20.6% vs 13.1% during follow-up, p < 0.008). Multivariate Cox regression analysis showed that COPD is still an independent risk factor for all-cause mortality (HR: 1.25, 95% CI: 1.03–1.51, p=0.022), and stroke (HR: 1.19, 95% CI: 1.00–1.41, p=0.039). CONCLUSION: The presence of COPD is an independent risk factor for new-onset AF. COPD is independently associated with all-cause mortality and stroke in AF patients.

Simultaneous Closure of a Left Atrial Appendage through an Atrial Septal Defect and the Atrial Septal Defect

Left atrial appendage (LAA) occlusion can be employed as an alternative treatment to oral anticoagulation in patients with atrial fibrillation to prevent embolic events. Atrial septal defect (ASD) may be related with right heart dysfunction and allow paradoxical embolism to occur. However, occlusion of both LAA through atrial access with ostium secundum ASD and ASD in the same setting is unusual. Therefore, we report a case in which a LAA and an ASD was sequentially occluded.