Niacin fails to prevent cardiovascular events

Observational studies have consistently demonstrated that levels of LDL cholesterol directly correlate with cardiovascular risk while HDL levels are inversely related to cardiovascular risk. Niacin is known to reduce LDL levels and concurrently raise HDL levels. In the HPS2-THRIVE study, 25,673 patients with a background of vascular disease were randomized to receive 2 g of extended-release niacin and 40 mg of laropiprant (an anti-flushing agent) or a matching placebo daily. Prior to starting the study, in a run-in phase, background statin therapy was standardized with simvastatin 40 mg +/− ezetimibe and all participants underwent a trial of the niacin preparation in order to establish tolerability. The primary end-point was time to first major cardiovascular event (nonfatal myocardial infarction, death from coronary causes, stroke, or …