Role of Niacin in Current Clinical Practice: A Systematic Review

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• 作者：Aakash Garg ; MD^a ; Abhishek Sharma ; MD^b ; ^{abhisheksharma4mamc@gmail.com} ; Parasuram Krishnamoorthy ; MD^c ; Jalaj Garg ; MD^d ; Deepti Virmani ; MD^e ; Toishi Sharma ; MD^f ; Giulio Stefanini ; MD^g ; John B. Kostis ; MD^h ; Debabrata Mukherjee ; MD ; MSⁱ ; Ekaterina Sikorskaya ; MD^j
• 关键词：Cardiovascular risk ; High-density lipoprotein cholesterol ; Niacin
• 刊名：The American Journal of Medicine
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：130
• 期：2
• 页码：173-187
• 全文大小：2495 K
• 卷排序：130

文摘

Niacin, a potent high-density lipoprotein cholesterol-raising drug, seems an attractive approach to reduce cardiac events in patients with or at risk of atherosclerotic cardiovascular disease. However, previous evidence for niacin has been challenged recently by negative outcomes in 2 large, randomized, controlled trials comparing niacin to placebo with background statin therapy. We studied the currently available evidence for the role of niacin treatment for reducing the risk of cardiovascular events in current practice.MethodsA systematic review of randomized controlled trials in the MEDLINE, EMBASE, CINAHL, and Cochrane databases comparing niacin alone or combined with statin therapy was performed. We extracted trial level data, including basic characteristics and number of patients enrolled, duration of follow up, occurrence of adverse events, and cardiovascular-related outcomes. Random effects meta-analysis was conducted to estimate the risk ratio (RR) for individual trial endpoints.ResultsThirteen trials (N = 35,206) were selected for final analysis. The mean follow-up duration was 32.8 months. Overall, niacin led to significant increases in serum high-density lipoprotein cholesterol levels from baseline trial enrolment by 21.4%, 9.31 (95% confidence interval [CI] 5.11-13.51) mg/dL. However, we did not observe any differences in all-cause mortality rates (RR 0.99; 95% CI 0.88-1.12) between niacin and control arms. Further, niacin treatment was associated with a trend toward lower risk of cardiovascular mortality (RR 0.91; 95% CI 0.81-1.02), coronary death (RR 0.93; 95% CI 0.78-1.10), nonfatal myocardial infarction (RR 0.85; 95% CI 0.73-1.0), revascularization (coronary and noncoronary) (RR 0.83; 95% CI 0.65-1.06), and stroke (RR 0.89; 95% CI 0.72-1.10), compared with control.ConclusionNiacin therapy does not lead to significant reductions in total or cause-specific mortality or recurrent cardiovascular events among persons with or at risk of atherosclerotic cardiovascular disease.