Assessment of the Role of Niacin in Managing Cardiovascular Disease Outcomes: A Systematic Review and Meta-analysis
D'Andrea E, Hey SP, Ramirez CL, Kesselheim AS
JAMA network open · 76 citas
Cómo se estudió
- Diseño
- Metaanálisis (indexado por PubMed)
- Estudiado en
- Personas
- Resultado principal
- Eventos clínicos como enfermedad o muerte
Quién lo pagó
- Financiación
- Financiación independiente
- Organización sin fines de lucro
- Laura and John Arnold Foundation
- Organización sin fines de lucro
- Engelberg Foundation
Según 2 financiadores declarados y la declaración de financiación del texto completo.
Publicación
- Publicado
- 2019-04-12 · JAMA Netw Open · vol. 2 · número 4 · pág. e192224
- Editorial
- American Medical Association
- Citado
- 95 citas · más que el 98% de estudios similares · 7.3× el promedio de su campo
- Impacto
- Entre el 10 % más citado de su campo
- Referencias
- 61 trabajos
- Acceso
- Acceso abierto (revista) · CC-BY
- Áreas de investigación
- Lipoproteins and Cardiovascular Health · Antiplatelet Therapy and Cardiovascular Diseases · Folate and B Vitamins Research
- Palabras clave
- nicotinic acid, cardiovascular disease prevention, secondary prevention, HDL cholesterol, coronary heart disease mortality, acute coronary syndrome, stroke, revascularization, major adverse cardiac events, statin intolerance, dyslipidemia, lipid control, cardiovascular outcomes, statin-sparing therapy
- MeSH
- humans, cardiovascular diseases, niacin, lipoproteins, hdl, treatment outcome, odds ratio, adult, aged, middle aged, united states, female, male, secondary prevention, hypolipidemic agents
4 autores
- Elvira D’Andrea🇺🇸 · autor de correspondenciaBrigham and Women's Hospital; Harvard University
- Spencer Phillips Hey🇺🇸Brigham and Women's Hospital; Harvard University
- Cherie L. Ramirez🇺🇸Brigham and Women's Hospital; Harvard University
- Aaron Seth Kesselheim🇺🇸Brigham and Women's Hospital; Harvard University
Resumen
El texto original del estudio, en el idioma en que se publicó.
Importance
Niacin remains a therapeutic option for patients with cardiovascular disease, but recent studies have called into question the effectiveness of other drugs that increase high-density lipoprotein cholesterol levels.
Objective
To systematically review and evaluate the evidence supporting current US Food and Drug Administration-approved uses of niacin in cardiovascular disease prevention settings.
Data sources
MEDLINE, Embase, Cochrane Controlled Clinical Trial Register (Central), ClinicalTrials.gov, and TrialResults-center, from database inception to October 2017.
Study selection
The systematic review included clinical trials involving niacin as a treatment for cardiovascular disease. The meta-analysis included randomized clinical trials reporting niacin's effect, as exposure, on at least 1 long-term cardiovascular disease outcome.
Data extraction and synthesis
Aggregate study-level data were extracted between November 2017 and January 2018 by 3 independent reviewers, and the analysis was performed in February 2018. Inverse-variance weighted methods were used to produce pooled risk ratios using random-effects models for between-study heterogeneity. Random effects-weighted metaregression analysis was used to assess the association of change in high-density lipoprotein cholesterol levels with the log risk ratio of the pooled results.
Main outcomes and measures
Cardiovascular disease, coronary heart disease mortality, and other cardiovascular events, including acute coronary syndrome, fatal and nonfatal stroke, revascularization, and major adverse cardiac events.
Results
Of 119 clinical trials, 17 documented niacin's effect on at least 1 cardiovascular disease outcome. The meta-analysis included 35 760 patients with histories of cardiovascular disease or dyslipidemia. Cumulative evidence found no preventive association of niacin with cardiovascular outcomes in secondary prevention. Stratified meta-analysis showed an association of niacin monotherapy with reduction of some cardiovascular events among patients without statin treatment (acute coronary syndrome: relative risk, 0.74; 95% CI, 0.58-0.96; stroke: relative risk, 0.74; 95% CI, 0.59-0.94; revascularization: relative risk, 0.51; 95% CI, 0.37-0.72). These results were mainly derived from 2 trials conducted in the 1970s and 1980s.
Conclusions and relevance
Niacin may have some use in lipid control for secondary prevention as monotherapy, perhaps in patients intolerant to statins, but evidence is from older studies on a population potentially not representative of current-day patients.
Resumen vía Europe PMC. Los derechos de autor siguen siendo de los autores o la editorial (CC BY).
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