Abstract 13041: An Updated Meta-Analysis and Meta-Regression of Niacin in Cardiovascular Prevention
Introduction: AIM-HIGH trial and Heart Protection Study 2 (HPS 2) THRIVE failed to demonstrate a significant reduction in cardiovascular (CV) events when niacin was added to statins (with or without ezetimibe) in high risk patients that achieved low cholesterol levels. These results were discordant with previous randomized trials and meta-analyses that showed the clinical benefit of niacin as monotherapy or combined to lipid-lowering therapy.
Hypothesis: The purpose of this meta-analysis was to assess the efficacy of niacin for reducing cardiovascular events, adding clinical data from the Harvard Atherosclerosis Reversibility Project (HARP) and HPS 2 THRIVE to revised outcomes of trials included in two previous meta-analyses.
Methods: Odds ratios (ORs) for four cardiovascular disease endpoints were calculated with a random-effects meta-analysis. Random meta-regression analyses were done to model the relationship between differences in on-treatment low-density cholesterol (LDL-C) and high-density cholesterol (HDL-C) and the size of effect of niacin on CV risk.
Results: Thirteen eligible trials, including 35,723 subjects were identified. Niacin use was associated with a significant reduction in the composite endpoints of any CV event (OR: 0.73; 95% CI: 0.59 to 0.89; p=0.003; I2 =65%), major coronary heart disease events (OR: 0.80; 95% CI: 0.65 to 0.98; p=0.03; I2 =54%) and any revascularization (OR: 0.59; 95% CI: 0.40 to 0.86; p=0.006; I2 = 58%). No significant association was observed between niacin therapy and stroke incidence (OR: 0.93; 95% CI: 0.70 to 1.24; p=0.64). Meta-regression analysis showed no significant relationship between the difference in on-treatment HDL-C and the natural log-adjusted OR for any CV event (p =0.36). The relationship between the amount of on-treatment LDL-C difference between arms and the effect of niacin on outcomes showed a positive trend that did not reach statistical significance.
Conclusions: This meta-analysis strongly suggests that niacin reduces CV events and that this may occur through a mechanism not reflected by changes in HDL-C and not fully explained by LDL-C reduction. Niacin could be useful for CV prevention in patients who do not respond adequately to intensive doses of statins.
Author Disclosures: D. Siniawski: None. W. Masson: None. C. Belziti: None.
- © 2014 by American Heart Association, Inc.