Atherosclerosis
Volume 210, Issue 2 , Pages 353-361, June 2010

Meta-analysis of the effect of nicotinic acid alone or in combination on cardiovascular events and atherosclerosis

  • Eric Bruckert

      Affiliations

    • Department of Endocrinology, Pitié-Salpêtrière University Hospital, Pierre and Marie Curie University, 83 bd de l’hôpital, 75651, Paris, France
    • Corresponding Author InformationCorresponding author. Tel.: +33 1 4217 7868; fax: +33 1 4217 7865.
    • ,
  • Julien Labreuche

      Affiliations

    • INSERM U-698 and Denis Diderot University, Paris VII, France
    • Department of Neurology and Stroke Center, Bichat University Hospital, Paris, France
    • ,
  • Pierre Amarenco

      Affiliations

    • INSERM U-698 and Denis Diderot University, Paris VII, France
    • Department of Neurology and Stroke Center, Bichat University Hospital, Paris, France

Received 4 November 2009; received in revised form 27 November 2009; accepted 14 December 2009. published online 18 January 2010.

Abstract 

Objective

High-density lipoprotein cholesterol (HDL-C) concentration is a strong predictor of cardiovascular events in both naïve and statin-treated patients. Nicotinic acid is an attractive option for decreasing residual risk in statin-treated or statin-intolerant patients since it increases HDL-C by up to 20% and decreases low-density lipoprotein cholesterol and lipoprotein(a) plasma concentrations.

Methods

We performed a computerized PubMed literature search that focused on clinical trials evaluating niacin, alone or in combination with other lipid-lowering drugs, published between January 1966 and August 2008.

Results

Among 587 citations, 29 full articles were read and 14 were eligible for inclusion. Overall 11 randomized controlled trials enrolled 2682 patients in the active group and 3934 in the control group. In primary analysis, niacin significantly reduced major coronary events (relative odds reduction=25%, 95% CI 13, 35), stroke (26%, 95% CI=8, 41) and any cardiovascular events (27%, 95% CI=15, 37). Except for stroke, the pooled between-group difference remained significant in sensitivity analysis excluding the largest trial. In comparison with the non-niacin group, more patients in the niacin group had regression of coronary atherosclerosis (relative increase=92%, 95% CI=39, 67) whereas the rate of patients with progression decreased by 41%, 95% CI=25, 53. Similar effects of niacin were found on carotid intima thickness with a weighted mean difference in annual change of −17μm/year (95% CI=−22, −12).

Conclusions

Although the studies were conducted before statin therapy become standard care, and mostly in patients in secondary prevention, with various dosages of nicotinic acid 1–3g/day, this meta-analysis found positive effects of niacin alone or in combination on all cardiovascular events and on atherosclerosis evolution.

Keywords: Nicotinic acid, Cardiovascular disease, Stroke, Atherosclerosis, Intima media thickness, Meta-analysis

To access this article, please choose from the options below

Login to an existing account or Register a new account.

  • Purchase this article for 31.50 USD (You must login/register to purchase this article)

    Online access for 24 hours. The PDF version can be downloaded as your permanent record.

  • Subscribe to this title

    Get unlimited online access to this article and all other articles in this title 24/7 for one year.

  • Claim access now

    For current subscribers with Society Membership or Account Number.

  • Visit SciVerse ScienceDirect to see if you have access via your institution.
 

PII: S0021-9150(09)01031-4

doi:10.1016/j.atherosclerosis.2009.12.023

Atherosclerosis
Volume 210, Issue 2 , Pages 353-361, June 2010

Article Tools

* Image Usage & Resolution