Clinical research studyRole of Niacin in Current Clinical Practice: A Systematic Review
Section snippets
Study Selection
We performed a systematic literature search for studies testing niacin in comparison with a control agent in the MEDLINE, EMBASE, EBSCO, CINAHL, Web of Science, and Cochrane databases. The review was conducted in accordance with PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines.25
Key words of interest were “niacin,” “nicotinic acid,” “HDL-C,” “cardiovascular,” and “randomized trial,” used in different combinations. The search period was restricted from
Study Characteristics
The initial search identified a total of 1296 publications that were screened at the abstract level. Among these, 13 randomized clinical trials met the aforementioned inclusion criteria and were included in the final analysis (Figure 1). These studies included a total of 35,206 patients (with or at-risk of ASCVD), with 16,858 randomized to the niacin arm and 18,348 to the control arm. The mean duration of follow-up was 32.8 months (range, 6-74 months).
Baseline characteristics of subjects and
Discussion
Our results showed that the addition of niacin to statin therapy was associated with a significant increase in serum levels of HDL-C and nonsignificant decreases in TC and LDL-C compared with placebo. However, niacin therapy did not lead to significant reductions in all-cause mortality, cardiovascular-related mortality, myocardial infarction, revascularization, or stroke among patients with established or at-high risk of ASCVD.
Despite the widespread use of statins as first-line therapy,
Conclusion
Niacin therapy does not lead to a significant reduction in total or cause-specific mortality or recurrent cardiovascular events, despite an improvement in serum HDL-C levels. Additional research is indicated to better understand HDL subfractions and their association with cardiovascular outcomes with targeted therapies, to increase only those subfractions associated with better cardiovascular outcomes.
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Funding: None.
Conflict of Interest: None.
Authorship: All authors had access to the data and a significant role in writing the manuscript.