- Niacin as add-on to statins is linked to increased adverse event risk, even in those with low high-density lipoprotein (HDL) cholesterol and high triglycerides, who had been viewed as having less risk.
- No subgroup in this trial (Heart Protection Study 2-Treatment of HDL to Reduce the Incidence of Vascular Events, or HPS2-THRIVE) stood out as having relatively less risk for such events.
Why this matters
- These authors say clinicians should consider these risks when contemplating adding niacin to a statin regimen, especially given the lack of evidence for cardiovascular benefits from niacin.
- The adverse events associated (HRs; 95% CIs) with niacin-laropiprant use included:
- New-onset diabetes: 1.33 (1.16-1.52);
- Disturbance in control of existing diabetes: 1.56 (1.35-1.80);
- Serious bleeding (mostly intracranial or gastrointestinal): 1.38 (1.17-1.63);
- About one-fifth of these bleeds were fatal; and
- Serious infection (mostly respiratory, urinary tract): 1.22 (1.11-1.34).
- Risks for most of these peaked in the first year of niacin use.
- Randomised, double-blind trial comparing 2000/40 mg/day niacin-laropiprant vs placebo in 25,673 people with high vascular disease risk.
- Trial enrolled from January 2007 to May 2010; median follow-up, 3.9 years.
- Funding: Merck & Co., Inc., Kenilworth, NJ, USA.
- Trial design allowed for selection of participants with short-term tolerance.