Author + information
- Received June 27, 2012
- Revision received October 15, 2012
- Accepted October 28, 2012
- Published online January 29, 2013.
- Paul M. Lavigne, MD and
- Richard H. Karas, MD, PhD⁎ ()
- Molecular Cardiology Research Institute, Division of Cardiology, Department of Medicine, Tufts Medical Center, Boston, Massachusetts
- ↵⁎Reprint requests and correspondence:
Dr. Richard H. Karas, Molecular Cardiology Research Center, Tufts Medical Center, 800 Washington Street, #80, Boston, Massachusetts 02111
Objectives This study sought to assess the efficacy of niacin for reducing cardiovascular disease (CVD) events, as indicated by the aggregate body of clinical trial evidence including data from the recently published AIM-HIGH (Atherothrombosis Intervention in Metabolic Syndrome with Low HDL/High Triglycerides: Impact on Global Health Outcomes) trial.
Background Previously available randomized clinical trial data assessing the clinical efficacy of niacin has been challenged by results from AIM-HIGH, which failed to demonstrate a reduction in CVD event incidence in patients with established CVD treated with niacin as an adjunct to intensive simvastatin therapy.
Methods Clinical trials of niacin, alone or combined with other lipid-altering therapy, were identified via MEDLINE. Odds ratios (ORs) for CVD endpoints were calculated with a random-effects meta-analyses. Meta-regression modeled the relationship of differences in on-treatment high-density lipoprotein cholesterol with the magnitude of effect of niacin on CVD events.
Results Eleven eligible trials including 9,959 subjects were identified. Niacin use was associated with a significant reduction in the composite endpoints of any CVD event (OR: 0.66; 95% confidence interval [CI]: 0.49 to 0.89; p = 0.007) and major coronary heart disease event (OR: 0.75; 95% CI: 0.59 to 0.96; p = 0.02). No significant association was observed between niacin therapy and stroke incidence (OR: 0.88; 95% CI: 0.5 to 1.54; p = 0.65). The magnitude of on-treatment high-density lipoprotein cholesterol difference between treatment arms was not significantly associated with the magnitude of the effect of niacin on outcomes.
Conclusions The consensus perspective derived from available clinical data supports that niacin reduces CVD events and, further, that this may occur through a mechanism not reflected by changes in high-density lipoprotein cholesterol concentration.
Dr. Karas has received consulting fees from Abbott Laboratories and Merck. Dr. Lavigne has reported that he has no relationships relevant to the contents of this paper to disclose.
- Received June 27, 2012.
- Revision received October 15, 2012.
- Accepted October 28, 2012.
- 2013 American College of Cardiology Foundation