Meta-analysis of the effect of nicotinic acid alone or in combination on cardiovascular events and atherosclerosis.
Level 1 - systematic review of randomized trials
Meta-analysis of randomized controlled trials
PubMed 20079494 · doi:10.1016/j.atherosclerosis.2009.12.023
What was done
A PubMed search (January 1966 to August 2008) identified randomized controlled trials evaluating nicotinic acid (1–3 g/day), alone or with other lipid-lowering therapies, on cardiovascular events and atherosclerosis progression. Out of 587 screened citations and 29 full articles reviewed, 14 articles reporting on 11 randomized controlled trials were included, comprising 2,682 patients in active treatment groups and 3,934 in control groups.
What was found
In primary analyses, niacin significantly reduced major coronary events (relative odds reduction = 25%, 95% CI 13 to 35), stroke (26%, 95% CI 8 to 41), and any cardiovascular event (27%, 95% CI 15 to 37). Excluding the largest trial in sensitivity analysis left all pooled effects significant except stroke. For structural vascular measures, niacin increased coronary atherosclerosis regression (relative increase = 92%, 95% CI 39 to 67) and reduced progression (relative reduction = 41%, 95% CI 25 to 53). Carotid intima-media thickness progression was reduced with a weighted mean difference of -17 µm/year (95% CI -22 to -12).
Why it matters
This meta-analysis synthesized historical evidence showing that nicotinic acid significantly improves both hard cardiovascular outcomes and structural markers of atherosclerosis in secondary prevention.
Limits
The included trials were conducted before statins became standard of care, limiting generalizability to modern clinical practice. Dosages varied from 1 to 3 g/day across trials. The abstract reports an apparent typographic inconsistency in the confidence interval for atherosclerosis regression (point estimate 92% vs 95% CI 39–67%). Adverse effects and discontinuation rates were not reported in the abstract.
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