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Niacin fails to reduce vascular events in large randomised trial

BMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g4774 (Published 23 July 2014) Cite this as: BMJ 2014;349:g4774
  1. Michael McCarthy
  1. 1Seattle

In a large randomised clinical trial, treatment with extended release niacin, combined with a drug to reduce common side effects of niacin, did not significantly reduce major vascular events but was associated with serious adverse events.

The trial, Heart Protection Study 2—Treatment of HDL to Reduce the Incidence of Vascular Events (HPS2-THRIVE), was designed to assess the effects of adding extended release niacin in combination with laropiprant to the treatment regimen for high risk patients who were already taking an effective statin based treatment to reduce concentrations of low density lipoprotein (LDL) cholesterol.

Niacin is thought to reduce the risk of cardiovascular disease by lowering LDL cholesterol concentrations and raising those of high density lipoprotein (HDL) cholesterol, which is thought to be protective. Niacin is therefore often recommended to patients who have a combination of low HDL cholesterol and high triglyceride concentrations.

Laropiprant is an antagonist of the prostaglandin D2 receptor DPq and reduces flushing, a common side effect of niacin treatment, improving adherence.

For the trial the researchers enrolled more than 25 000 men and women aged 50 to 80 years who had a history of myocardial infarction, cerebrovascular disease, peripheral arterial disease, or diabetes mellitus with evidence of symptomatic coronary disease. …

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