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 −17 μm/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
1–3 g/day, this meta-analysis found positive effects of niacin alone or in combination
on all cardiovascular events and on atherosclerosis evolution.
Keywords
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Article info
Publication history
Published online: January 18, 2010
Accepted:
December 14,
2009
Received in revised form:
November 27,
2009
Received:
November 4,
2009
Identification
Copyright
© 2010 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
