Evidence for... Niacin for heart disease prevention

Efficacy and safety of high-density lipoprotein cholesterol-increasing compounds: a meta-analysis of randomized controlled trials.
Birjmohun RS et al.
J Am Coll Cardiol. 2005;45:185-97.
Data from 53 trials (16,802 subjects) using fibrates and 30 trials (4749 subjects) using niacin were examined, to estimate the efficacy and safety of current high-density lipoprotein cholesterol (HDL-C)-increasing drugs. Fibrates and niacin were associated, respectively, with 11% vs 10% reduction in total cholesterol, 36% vs 20% reduction in triglycerides, 8% vs 14% reduction in low-density lipoprotein cholesterol, and 10% vs 16% increase in HDL-C. Neither treatment was associated with significant toxicity.


Simvastatin and niacin, antioxidant vitamins, or the combination for the prevention of coronary disease.
Brown BG et al.
N Engl J Med. 2001;345:1583-92.
In patients with coronary disease and low levels of high-density lipoprotein cholesterol (HDL-C), 3 years' combination therapy with simvastatin and niacin resulted in marked clinical and angiographically measurable benefits; concurrent antioxidant vitamin therapy attenuated the response of HDL-C to simvastatin plus niacin therapy.


Long-term safety and efficacy of a once-daily niacin/lovastatin formulation for patients with dyslipidemia.
Kashyap ML et al.
Am J Cardiol. 2002;89:672-8.
Once-daily extended-release niacin and lovastatin was used to treat 814 men and women (mean age 59 years) with dyslipidaemia, in 4 escalating doses: (niacin/lovastatin in milligrams): 500/10 for the first month, 1000/20 for the second, 1500/30 for the third, and 2000/40 for the fourth month, through week 52. Treatment was associated with substantial and beneficial effects on multiple lipid risk factors.