Niacin for primary and secondary prevention of cardiovascular events

Schandelmaier, Stefan; Briel, Matthias; Saccilotto, Ramon; Olu, Kelechi K; Arpagaus, Armon; Hemkens, Lars G; Nordmann, Alain

doi:10.1002/14651858.cd009744.pub2

Cited by 62 publications

(48 citation statements)

References 158 publications

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“…This translates into reductions in LDL-C and triglycerides whilst concomitantly raising HDL-C [ 103 , 104 ]. Despite the lack of cardiovascular efficacy when added to background statin therapy [ 105 ], its ubiquitous use continues worldwide [ 101 , 106 ]. Niacin often causes facial flushing as a side effect, which sometimes limits its use in general practice [ 107 ].…”

Section: Recommendationsmentioning

confidence: 99%

Managing hyperlipidaemia in patients with COVID-19 and during its pandemic: An expert panel position statement from HEART UK

Iqbal

Adam

et al. 2020

Atherosclerosis

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Background & aims The emergence of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which causes Coronavirus Disease 2019 (COVID-19) has resulted in a worldwide pandemic. SARS-CoV-2 is highly contagious and its severity highly variable. The fatality rate is unpredictable but is amplified by several factors including advancing age, atherosclerotic cardiovascular disease, diabetes mellitus, hypertension and obesity. A large proportion of patients with these conditions are treated with lipid lowering medication and questions regarding the safety of continuing lipid-lowering medication in patients infected with COVID-19 have arisen. Some have suggested they may exacerbate their condition. It is important to consider known interactions with lipid-lowering agents and with specific therapies for COVID-19. This statement aims to collate current evidence surrounding the safety of lipid-lowering medications in patients, who have COVID-19. We offer a consensus view based on current knowledge and we rated the strength and level of evidence for these recommendations. Methods Pubmed, Google scholar and Web of Science were searched extensively for articles using search terms: SARS-CoV-2, COVID-19, coronavirus, Lipids, Statin, Fibrates, Ezetimibe, PCSK9 monoclonal antibodies, nicotinic acid, bile acid sequestrate, nutraceuticals, red yeast rice, Omega-3-Fatty acids, Lomitapide, hypercholesterolaemia, dyslipidaemia and Volanesorsen. Results & Conclusions : There is no evidence currently that lipid lowering therapy is unsafe in patients with COVID-19 infection. Lipid-lowering therapy should not be interrupted because of the pandemic or in patients at increased risk of COVID-19 infection. In patients with confirmed COVID-19, care should be taken to avoid drug interactions, between lipid-lowering medications and drugs that may be used to treat COVID-19, especially in patients with abnormalities in liver function tests.

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Section: Recommendationsmentioning

confidence: 99%

Managing hyperlipidaemia in patients with COVID-19 and during its pandemic: An expert panel position statement from HEART UK

Iqbal

Adam

et al. 2020

Atherosclerosis

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“…There is considerable evidence revealing that elevated level of plasma LDL-C is the independent risk factors for CVD [ 16 , 63 , 64 ]. Recently, other studies have also shown that elevated plasma TG levels also play an important role in the development of CVD [ 65 , 66 ]. Targeting on LDL-C and TG may effectively prevent the progress of CVD.…”

Section: The Function Of Angptl3mentioning

confidence: 99%

New insights into ANGPLT3 in controlling lipoprotein metabolism and risk of cardiovascular diseases

Peng

2018

Lipids Health Dis

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Dyslipidemia, characterized by elevation of plasma low density lipoprotein cholesterol (LDL-C), triglyceride (TG) and reduction of plasma high density lipoprotein cholesterol (HDL-C), has been verified as a causal risk factor for cardiovascular diseases (CVD), leading to a high mortality rate in general population. It is important to understand the molecular metabolism underlying dyslipidemia in order to reduce the risk and to develop effective therapeutic approaches against CVD. ANGPTL3 (human) or Angptl3 (mouse), one member of the angiopoietin-like protein (ANGPTL) family, has been identified as an important regulator of lipid metabolism by inhibiting LPL and EL activity. Results have demonstrated that inactivation of Angptl3 in mice could obviously reduce the level of TG, LDL-C and the atherosclerotic lesion size, leading to a lower risk for dyslipidemia and CVD. Additionally, in humans, carriers with homozygous LOF mutations in ANGPTL3 have lower plasma LDL-C, TG levels and lower risk of atherosclerosis compared to the non-carriers. Here, we collect the latest data and results, giving a new insight into the important role of ANGPTL3 in controlling lipoprotein metabolism. Finally, we introduce two update reports on the antisense oligonucleotide and monoclonal antibody-based inactivation of ANGPTL3 in human clinical trials, to identify that ANGPTL3 could be a novel and effective target for the treatment of dyslipidemia and CVD.

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“…These findings are consistent with quantitative syntheses from previous meta-analyses. 46 , 47 By contrast, pooled estimates of the trials performed on the subgroup of patients without concurrent statin therapy indicated an association of niacin with 3 clinical outcomes, often reported as secondary end points: a reduced risk for acute coronary syndrome, stroke, and revascularization procedures.…”

Section: Discussionmentioning

confidence: 99%

Assessment of the Role of Niacin in Managing Cardiovascular Disease Outcomes

et al. 2019

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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.

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Niacin for primary and secondary prevention of cardiovascular events

Abstract: Trusted evidence. Informed decisions. Better health.

Cited by 62 publications

References 158 publications

Managing hyperlipidaemia in patients with COVID-19 and during its pandemic: An expert panel position statement from HEART UK

Managing hyperlipidaemia in patients with COVID-19 and during its pandemic: An expert panel position statement from HEART UK

New insights into ANGPLT3 in controlling lipoprotein metabolism and risk of cardiovascular diseases

Assessment of the Role of Niacin in Managing Cardiovascular Disease Outcomes

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