title: Effect of extended-release niacin on plasma lipoprotein(a) levels: A systematic review and meta-analysis of randomized placebo-controlled trials.
abstract: OBJECTIVE
  Lipoprotein(a) (Lp(a)) is a proatherogenic and prothrombotic lipoprotein. Our aim was to quantify the extended-release nicotinic acid Lp(a) reducing effect with a meta-analysis of the available randomized clinical trials.
  
  
  METHODS
  A meta-analysis and random-effects meta-regression were performed on data pooled from 14 randomized placebo-controlled clinical trials published between 1998 and 2015, comprising 17 treatment arms, which included 9013 subjects, with 5362 in the niacin arm.
  
  
  RESULTS
  The impact of ER niacin on plasma Lp(a) concentrations was reported in 17 treatment arms. Meta-analysis suggested a significant reduction of Lp(a) levels following ER niacin treatment (weighted mean difference - WMD: -22.90%, 95% CI: -27.32, -18.48, p<0.001). Results also remained similar when the meta-analysis was repeated with standardized mean difference as summary statistic (WMD: -0.66, 95% CI: -0.82, -0.50, p<0.001). When the studies were categorized according to the administered dose, there was a comparable effect between the subsets of studies with administered doses of <2000mg/day (WMD: -21.85%, 95% CI: -30.61, -13.10, p<0.001) and ≥2000mg/day (WMD: -23.21%, 95% CI: -28.41, -18.01, p<0.001). The results of the random-effects meta-regression did not suggest any significant association between the changes in plasma concentrations of Lp(a) with dose (slope: -0.0001; 95% CI: -0.01, 0.01; p=0.983), treatment duration (slope: -0.40; 95% CI: -0.97, 0.17; p=0.166), and percentage change in plasma HDL-C concentrations (slope: 0.44; 95% CI: -0.48, 1.36; p=0.350).
  
  
  CONCLUSIONS
  In this meta-analysis of randomized placebo-controlled clinical trials, treatment with nicotinic acid was associated with a significant reduction in Lp(a) levels.
authors.affiliation: Biotechnology Research Center, Mashhad University of Medical Sciences, Mashhad, 9177948564, Iran; Metabolic Research Centre, Royal Perth Hospital, School of Medicine and Pharmacology, University of Western Australia, Perth, Australia.
authors.forename: Amirhosssein
authors.initials: A
authors.lastname: Sahebkar
authors.affiliation: University Hospital Center Zagreb, Department of Internal medicine, Kišpatićeva 12, Zagreb, Croatia.
authors.forename: Željko
authors.initials: Ž
authors.lastname: Reiner
authors.affiliation: Biomedical Research Unit, Mexican Social Security Institute, Durango, Mexico.
authors.forename: Luis E
authors.initials: LE
authors.lastname: Simental-Mendía
authors.affiliation: Dipartimento di Scienze cliniche Specialistiche ed Odontostomatologiche (DISCO), Università Politecnica delle Marche, Italy.
authors.forename: Gianna
authors.initials: G
authors.lastname: Ferretti
authors.affiliation: Medicine and Surgery Sciences Dept., Alma Mater Studiorum University of Bologna, Italy. Electronic address: arrigo.cicero@unibo.it.
authors.forename: Arrigo F G
authors.initials: AF
authors.lastname: Cicero
mesh_terms: D003692:Delayed-Action Preparations; D019587:Dietary Supplements; D006801:Humans; D000960:Hypolipidemic Agents / Q000008:administration & dosage / Q000494:pharmacology*; D017270:Lipoprotein(a) / Q000097:blood*; D009525:Niacin / Q000008:administration & dosage / Q000494:pharmacology*; D016032:Randomized Controlled Trials as Topic
chemical_list: D003692:Delayed-Action Preparations; D000960:Hypolipidemic Agents; D017270:Lipoprotein(a); D009525:Niacin
keywords: Extended release niacin; Lipoprotein(a); Meta-analysis; Systematic review