Eric Bruckert1, Julien Labreuche, Pierre Amarenco. 1. Department of Endocrinology, Pitié-Salpêtrière University Hospital, Pierre and Marie Curie University, 83 bd de l'hôpital, 75651, Paris, France. eric.bruckert@psl.aphp.fr
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 microm/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. Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved.
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 microm/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. Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved.
Authors: Stefan Schandelmaier; Matthias Briel; Ramon Saccilotto; Kelechi K Olu; Armon Arpagaus; Lars G Hemkens; Alain J Nordmann Journal: Cochrane Database Syst Rev Date: 2017-06-14
Authors: Maciej Banach; Piotr Jankowski; Jacek Jóźwiak; Barbara Cybulska; Adam Windak; Tomasz Guzik; Artur Mamcarz; Marlena Broncel; Tomasz Tomasik; Jacek Rysz; Agnieszka Jankowska-Zduńczyk; Piotr Hoffman; Agnieszka Mastalerz-Migas Journal: Arch Med Sci Date: 2016-12-19 Impact factor: 3.318