Niacin's role in the statin era

Importance of the field: The combination use of niacin and HMG Co-A reductases (statins) is increasing. While statin therapy reduces the risk of adverse cardiovascular events, additional therapies are needed to decrease event rates further. High-density lipoprotein cholesterol (HDL-C) is of interest as a potential therapeutic target as epidemiologic evidence demonstrates that low HDL-C is a strong predictor of incident coronary events. Niacin is the most effective agent available at present to increase HDL-C. Areas covered in this review: This review focuses on the efficacy and safety of niacin in combination with statins, along with the combination's effects on cardiovascular end points and clinical outcomes. We systematically reviewed studies, dating from 2001 to the present, identified through MEDLINE and searches of reference lists, which contained a combination statin and niacin group. What the reader will gain: The reader will gain an understanding of the rationale and results of using niacin and statin therapy concurrently. Take home message: The addition of niacin to statin therapy results in multiple favorable effects on lipid levels, and the combination seems to be as safe as the individual drugs separately. Current evidence indicates that adding niacin to statin therapy has the potential to result in substantial reductions in risk for adverse cardiovascular events. However, large-scale clinical outcome trials are needed to confirm the benefits of this combination.