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Niacin therapy and the risk of new-onset diabetes: a meta-analysis of randomised controlled trials
  1. Christina Goldie1,
  2. Allen J Taylor2,
  3. Peter Nguyen3,
  4. Cody McCoy4,
  5. Xue-Qiao Zhao5,
  6. David Preiss1
  1. 1BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
  2. 2Medstar Research Institute, Washington Hospital Center, Washington DC, USA
  3. 3Division of Cardiology, Medstar Georgetown University Hospital, Washington DC, USA
  4. 4University of Tennessee Health and Science Center, College of Medicine, Memphis, Tennessee, USA
  5. 5Cardiovascular Atherosclerosis Research Laboratory, Division of Cardiology, University of Washington, Seattle, Washington, USA
  1. Correspondence to Dr David Preiss, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow G12 8TA, UK; david.preiss{at}glasgow.ac.uk

Abstract

Objective Previous studies have suggested that niacin treatment raises glucose levels in patients with diabetes and may increase the risk of developing diabetes. We undertook a meta-analysis of published and unpublished data from randomised trials to confirm whether an association exists between niacin and new-onset diabetes.

Methods We searched Medline, EMBASE and the Cochrane Central Register of Controlled Trials, from 1975 to 2014, for randomised controlled trials of niacin primarily designed to assess its effects on cardiovascular endpoints and cardiovascular surrogate markers. We included trials with ≥50 non-diabetic participants and average follow-up of ≥24 weeks. Published data were tabulated and unpublished data sought from investigators. We calculated risk ratios (RR) for new-onset diabetes with random-effects meta-analysis. Heterogeneity between trials was assessed using the I2 statistic.

Results In 11 trials with 26 340 non-diabetic participants, 1371 (725/13 121 assigned niacin; 646/13 219 assigned control) were diagnosed with diabetes during a weighted mean follow-up of 3.6 years. Niacin therapy was associated with a RR of 1.34 (95% CIs 1.21 to 1.49) for new-onset diabetes, with limited heterogeneity between trials (I2=0.0%, p=0.87). This equates to one additional case of diabetes per 43 (95% CI 30 to 70) initially non-diabetic individuals who are treated with niacin for 5 years. Results were consistent regardless of whether participants received background statin therapy (p for interaction=0.88) or combined therapy with laropiprant (p for interaction=0.52).

Conclusions Niacin therapy is associated with a moderately increased risk of developing diabetes regardless of background statin or combination laropiprant therapy.

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

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