Does Niacin Therapy Prevent Cardiovascular Disease Events?

Researchers reviewed 23 randomized controlled trials that included 39,195 individuals
Researchers reviewed 23 randomized controlled trials that included 39,195 individuals

Niacin does not reduce mortality, cardiovascular mortality, non-cardiovascular mortality, the number of fatal or non-fatal myocardial infarctions, nor the number of fatal or non-fatal strokes, according to findings of a recent Cochrane review.

Niacin (nicotinic acid) decreases LDL cholesterol and triglycerides and increases HDL cholesterol levels. However, its benefits are “controversial,” when it comes to reducing cardiovascular events.

To investigate, Schandelmaier et al. reviewed 23 randomized controlled trials (n= 39,195 participants), which compared niacin monotherapy to placebo/usual care, or niacin in combination with another component vs. the other component alone. Trials had to be a minimum of 6 months. The mean age of participants ranged from 33 to 71 years, the median duration of treatment was 11.5 months, and the median dose of niacin was 2g/day.

The proportion of participants with prior myocardial infarction ranged from 0% (four trials) to 100%, and proportion of participants taking a statin drug ranged from 0% to 100%.

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The researchers found that niacin did not reduce overall mortality (RR 1.05, 95% CI 0.97 to 1.12; n=35,543; studies=12; high-quality evidence), cardiovascular mortality (RR 1.02, 95% CI 0.93 to 1.12; n=32,966; studies=5; moderate-quality evidence), non-cardiovascular mortality (RR 1.12, 95% CI 0.98 to 1.28; n=32,966; studies=5; high-quality evidence), the number of fatal or non-fatal myocardial infarctions (RR 0.93, 95% CI 0.87 to 1.00; n=34,829; studies=9; moderate-quality evidence), nor the number of fatal or non-fatal strokes (RR 0.95, 95% CI 0.74 to 1.22; n=33,661; studies=7; low-quality evidence).

Moreover, participants randomized to niacin were more likely to discontinue treatment due to side effects than those randomized to control groups (RR 2.17, 95% CI 1.70 to 2.77; n=33,539; studies=17; moderate-quality evidence).

The researchers concluded that moderate-to high-quality evidence suggests that niacin does not reduce CVD events and, in fact, is associated with side effects, therefore benefits from niacin therapy in the prevention of CVD events are “unlikely.”

Reference

Schandelmaier S, Briel M, Saccilotto R, Olu KK, Arpagaus A, Hemkens LG, Nordmann AJ. Niacin for primary and secondary prevention of cardiovascular events. Cochrane Database Syst Rev. 2017 Jun 14;6:CD009744.