title: Role of Niacin in Current Clinical Practice: A Systematic Review.
abstract: BACKGROUND
  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.
  
  
  METHODS
  A 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.
  
  
  RESULTS
  Thirteen 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.
  
  
  CONCLUSIONS
  Niacin 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.
authors: Department of Medicine, St. Peter's University Hospital, Rutgers/Robert Wood Johnson Medical School, New Brunswick, NJ.
authors: Aakash
authors: A
authors: Garg
authors: Division of Cardiovascular Medicine, State University of New York Downstate Medical Center, Brooklyn, NY. Electronic address: abhisheksharma4mamc@gmail.com.
authors: Abhishek
authors: A
authors: Sharma
authors: Department of Cardiovascular Medicine, Albert Einstein Medical Center, Philadelphia, Penn.
authors: Parasuram
authors: P
authors: Krishnamoorthy
authors: Department of Cardiology, Lehigh Valley Health Network, Allentown, Penn.
authors: Jalaj
authors: J
authors: Garg
authors: Department of Medicine, Albert Einstein College of Medicine, Bronx, NY.
authors: Deepti
authors: D
authors: Virmani
authors: Department of Medicine, Cleveland Clinic, Weston, Fla.
authors: Toishi
authors: T
authors: Sharma
authors: Division of Cardiology, Humanitas Research Hospital, Rozzano, Italy.
authors: Giulio
authors: G
authors: Stefanini
authors: Division of Cardiology, Cardiovascular Institute, Rutgers/Robert Wood Johnson Medical School, New Brunswick, NJ.
authors: John B
authors: JB
authors: Kostis
authors: Division of Cardiology, Texas Tech University, El Paso, Tex.
authors: Debabrata
authors: D
authors: Mukherjee
authors: Department of Internal Medicine, The Brooklyn Hospital Center, Brooklyn, NY.
authors: Ekaterina
authors: E
authors: Sikorskaya
mesh_terms: D002318:Cardiovascular Diseases / Q000517:prevention & control; D008076:Cholesterol, HDL / Q000097:blood; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D009525:Niacin / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D008076:Cholesterol, HDL; D000960:Hypolipidemic Agents; D009525:Niacin
keywords: Cardiovascular risk; High-density lipoprotein cholesterol; Niacin