Assessment of the Role of Niacin in Managing Cardiovascular Disease Outcomes

Key Points Question What is the evidence supporting the remaining US Food and Drug Administration–approved indications of niacin for patients with cardiovascular disease? Findings In a systematic review and meta-analysis of 119 clinical trials that included 35 760 participants, 17 trials reported niacin’s effect on cardiovascular outcomes and did not suggest that niacin prevents cardiovascular disease overall. However, a stratified meta-analysis showed that niacin as monotherapy was associated with a reduction of some cardiovascular events, a result primarily derived from 2 trials conducted in the 1970s and 1980s. Meaning Niacin may have a role as a monotherapy drug for lipid control in statin-intolerant patients, but, given substantial advancements in cardiovascular disease management since 1990, this indication should be restudied in current-day patients receiving usual baseline care.