title: Niacin therapy and the risk of new-onset diabetes: a meta-analysis of randomised controlled trials.
abstract: OBJECTIVE
  Previous studies have suggested that niacin treatment raises glucose levels in patients with diabetes and may increase the risk of developing diabetes. We undertook a meta-analysis of published and unpublished data from randomised trials to confirm whether an association exists between niacin and new-onset diabetes.
  
  
  METHODS
  We searched Medline, EMBASE and the Cochrane Central Register of Controlled Trials, from 1975 to 2014, for randomised controlled trials of niacin primarily designed to assess its effects on cardiovascular endpoints and cardiovascular surrogate markers. We included trials with ≥50 non-diabetic participants and average follow-up of ≥24 weeks. Published data were tabulated and unpublished data sought from investigators. We calculated risk ratios (RR) for new-onset diabetes with random-effects meta-analysis. Heterogeneity between trials was assessed using the I(2) statistic.
  
  
  RESULTS
  In 11 trials with 26 340 non-diabetic participants, 1371 (725/13 121 assigned niacin; 646/13 219 assigned control) were diagnosed with diabetes during a weighted mean follow-up of 3.6 years. Niacin therapy was associated with a RR of 1.34 (95% CIs 1.21 to 1.49) for new-onset diabetes, with limited heterogeneity between trials (I(2)=0.0%, p=0.87). This equates to one additional case of diabetes per 43 (95% CI 30 to 70) initially non-diabetic individuals who are treated with niacin for 5 years. Results were consistent regardless of whether participants received background statin therapy (p for interaction=0.88) or combined therapy with laropiprant (p for interaction=0.52).
  
  
  CONCLUSIONS
  Niacin therapy is associated with a moderately increased risk of developing diabetes regardless of background statin or combination laropiprant therapy.
authors.affiliation: BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.
authors.forename: Christina
authors.initials: C
authors.lastname: Goldie
authors.affiliation: Medstar Research Institute, Washington Hospital Center, Washington DC, USA.
authors.forename: Allen J
authors.initials: AJ
authors.lastname: Taylor
authors.affiliation: Division of Cardiology, Medstar Georgetown University Hospital, Washington DC, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Nguyen
authors.affiliation: University of Tennessee Health and Science Center, College of Medicine, Memphis, Tennessee, USA.
authors.forename: Cody
authors.initials: C
authors.lastname: McCoy
authors.affiliation: Cardiovascular Atherosclerosis Research Laboratory, Division of Cardiology, University of Washington, Seattle, Washington, USA.
authors.forename: Xue-Qiao
authors.initials: XQ
authors.lastname: Zhao
authors.affiliation: BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.
authors.forename: David
authors.initials: D
authors.lastname: Preiss
mesh_terms: D003920:Diabetes Mellitus / Q000453:epidemiology*; D004359:Drug Therapy, Combination; D050171:Dyslipidemias / Q000188:drug therapy; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D006937:Hypercholesterolemia / Q000188:drug therapy*; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D009525:Niacin / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000960:Hypolipidemic Agents; D009525:Niacin