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Document Details : Title: Niacin is still beneficial. Implications from an updated meta-regression analysis Author(s): D. Siniawski , C.G. Santos-Gallego , J.J. Badimon , W.M. Masson Journal: Acta Cardiologica Volume: 71 Issue: 4 Date: 2016 Pages: 463-472 DOI: 10.2143/AC.71.4.3159701 Abstract : Background: The AIM-HIGH and HPS2-THRIVE clinical trials failed to show significant reductions in cardiovascular events (CVE) when niacin was added to statins in high-risk patients with low cholesterol levels. These results were discordant with previous randomized trials that demonstrated the clinical benefit of niacin. Objective: The objective of this study was to assess the efficacy of niacin for reducing CVE performing and updated meta-analysis, adding the results of the HPS2-THRIVE to the full body of evidence. Methods: Odds ratios were calculated with random-effects meta-analyses. Exploratory meta-regression analyses were performed examining potential associations between differences in lipids levels between trial arms and the effect size of niacin on cardiovascular risk. Results: Thirteen eligible trials, including 35,723 subjects, were identified. Niacin therapy was associated with a significant reduction in any cardiovascular event (OR: 0.73; 95% CI: 0.59 to 0.90; P = 0.003), major coronary events (OR: 0.81; 95% CI: 0.66 to 0.99; P = 0.04) and any revascularization (OR: 0.59; 95% CI: 0.40 to 0.86; P = 0.006). Meta-regression analyses showed significant associations between the amount of on-treatment total cholesterol, non HDL-C and triglycerides differences and the natural log-adjusted OR for any CVE. No significant relationship was found between differences in HDL-C and the incidence of CVE. Conclusions: This meta-analysis demonstrates that niacin reduces CVE, despite the negative results of AIM-HIGH and HPS2-THRIVE. Niacin benefits seem to be mediated by the reduction in atherogenic particles and are independent of changes in HDL-C. Our results suggest that niacin remains an effective treatment as an add-on therapy in patients with insufficient response to statins. |
