title: Is HPS2-THRIVE the death knell for niacin?
abstract: Niacin is a lipid-modifying therapy with proven efficacy for reducing cardiovascular events as monotherapy and when used in combination with other lipid-modifying medications impacts rates of atherosclerotic disease progression. Large outcome trials using niacin against a background of statin therapy with optimal control of atherogenic lipoprotein burden in serum were unable to demonstrate incremental benefit of niacin beyond statin therapy. We address 2 key questions: (1) Can the results from randomized clinical trials performed in stable ischemic heart disease populations (AIM-HIGH and HPS2-THRIVE) be applied to patients who sustain an acute coronary syndrome or myocardial infarction? (2) Are patients with very low baseline levels of high-density lipoprotein cholesterol (<30 mg/dL) at particularly high risk for subsequent cardiac events?
authors.affiliation: CGH Medical Center, Sterling, IL, USA; Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Peter P
authors.initials: PP
authors.lastname: Toth
authors.affiliation: Department of Medicine, Bridgeport Hospital, Yale New Haven Health System, Yale University School of Medicine, Bridgeport, CT, USA.
authors.forename: Avinash M
authors.initials: AM
authors.lastname: Murthy
authors.affiliation: Department of Medicine, Albany Stratton VA Medical Center and Albany Medical Center, Albany Medical College, Albany, NY, USA.
authors.forename: Mandeep S
authors.initials: MS
authors.lastname: Sidhu
authors.affiliation: Department of Medicine, Albany Stratton VA Medical Center and Albany Medical Center, Albany Medical College, Albany, NY, USA. Electronic address: William.boden@va.gov.
authors.forename: William E
authors.initials: WE
authors.lastname: Boden
mesh_terms: D002986:Clinical Trials as Topic; D006801:Humans; D000960:Hypolipidemic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000188:drug therapy*; D009525:Niacin / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D000960:Hypolipidemic Agents; D009525:Niacin
keywords: Atherosclerosis; Coronary artery disease; High-density lipoprotein cholesterol; Niacin; Statin