<International Circulation>:This new preparation of niacin is not going to have the flushing reaction?

　　Dr Chapman: No. To be precise， the new preparation attenuates both the intensity and the frequency of the flushing reaction to the order of about 50-60% in the studies performed to-date. Why is that important? It is important because many patients are lost to niacin treatment over the first two weeks because that， of course， is when usually the greatest intensity and frequency of flushing occurs. The role of the new preparation is to attenuate that considerably and in addition， after a period of three to four months， intensity and frequency of flushing with this new niacin preparation comes back very close to placebo levels. Clearly this new preparation does offer us a new therapeutic window and of course our hope is that the HPS2-THRIVE trial will support combination therapy with niacin on top of a statin in patients with the atherogenic lipid triad involved in large numbers.

　　<International Circulation>:You said that the effects of fibrates in diabetics have been varied. Can you go into a little more detail on that? Is that contrary to the results of the ACCORD trial?

　　Dr Chapman: To be precise， in more than two trials， including the ACCORD trial， the overall effect on cardiovascular events of a fibrate have been equivocal on the primary endpoint. However， when post hoc analyses have been performed， in individuals with the high triglyceride， low HDL phenotype， a significant and a high degree of clinical benefit has been observed in terms of reduction of events. Unfortunately， many of us have reservations about post hoc analyses. Therefore we really need a new large prospective randomized controlled trial with a major fibrate on top of a statin both in diabetic and non-diabetic populations to clarify what is potentially a very important question.

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