Article

The Current State of Niacin in Cardiovascular Disease Prevention A Systematic Review and Meta-Regression

Molecular Cardiology Research Institute, Division of Cardiology, Department of Medicine, Tufts Medical Center, Boston, Massachusetts.
Journal of the American College of Cardiology (Impact Factor: 16.5). 12/2012; 61(4). DOI: 10.1016/j.jacc.2012.10.030
Source: PubMed

ABSTRACT

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: 0.49 to 0.89; p = 0.007) and major coronary heart disease event (OR: 0.75; 95% confidence interval: 0.59 to 0.96; p = 0.02). No significant association was observed between niacin therapy and stroke incidence (OR: 0.88; 95% confidence interval: 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.

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Available from: Paul M Lavigne, Jan 06, 2016
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    • "Similarly, both single intravenous and chronic oral mega-doses of biotin have been shown to improve lipid profiles in humans[144,145]. Finally, a meta-analysis of the data from 11 studies involving niacin supplementation confirmed that high doses (typically 1–4 g) either with or without statins reduced the incidence of cardiovascular disease and coronary heart disease events, but that this was not related to niacin's beneficial effects on blood lipid profiles[146]. Other potential mechanisms underlying these effects include beneficial effects on inflammatory biomarkers[147]via modulation of NIACR1 receptors[112]. "
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