Niacin, fibrates, and cholesterol ester transfer protein (CTEP) inhibitors may have raised HDL levels, but they showed no effect on all-cause mortality, coronary heart disease mortality, non-fatal myocardial infarction, and stroke, a meta-analysis concluded.
Researchers reviewed 39 randomized trials of more than 117,000 patients receiving drugs that raise HDL levels. The meta-analysis appeared at BMJ.
No significant effects were seen for:
• all-cause mortality: niacin (odds ratio [OR], 1.03; 95% CI, 0.92 to 1.15, P=0.59), fibrates (OR, 0.98; 95% CI, 0.89 to 1.08, P=0.66), or CETP inhibitors (OR, 1.16; 95% CI, 0.93 to 1.44, P=0.19);
• coronary heart disease mortality; niacin (OR, 0.93; 95% CI, 0.76 to 1.12, P=0.44), fibrates (OR, 0.92; 95% CI, 0.81 to 1.04, P=0.19), or CETP inhibitors (OR, 1.00; 95% CI, 0.80 to 1.24, P=0.99);
• stroke: niacin (OR, 0.96; 95% CI, 0.75 to 1.22, P=0.72), fibrates (OR, 1.01; 95% CI, 0.90 to 1.13, P=0.84), or CETP inhibitors (OR, 1.14; 95% CI, 0.90 to 1.45, P=0.29).
Before the statin era, niacin was associated with a significant reduction in non-fatal myocardial infarction (OR, 0.69; 95% CI, 0.56 to 0.85, P=0.0004) compared to having no effect in patients taking statins (OR, 0.96; 95% CI, 0.85 to 1.09, P=0.52) (P=0.007 for difference).
There was a similar trend for fibrates and non-fatal myocardial infarction for patients before the statin era (OR, 0.78; 95% CI, 0.71 to 0.86, P<0.001) and after (OR, 0.83; 95% CI, 0.69 to 1.01, P=0.07) (P=0.58 for difference).
The authors wrote, “Although observational studies might suggest a simplistic hypothesis for high density lipoprotein cholesterol, that increasing the levels pharmacologically would generally reduce cardiovascular events, in the current era of widespread use of statins in dyslipidemia, substantial trials of these 3 agents do not support this concept.”
The study follows another report that niacin did not significantly reduce vascular events and did cause a variety of serious side effects for high-risk patients.
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