Extended-release nicotinic acid supports lipoprotein(a) metabolism, meta-analysis shows

Summary

This meta-analysis was designed to quantify the effect of extended-release (ER) nicotinic acid on lowering the blood level of lipoprotein(a) or Lp(a), a proatherogenic and prothrombotic lipoprotein.

Study inclusion criteria was limited to randomized, placebo-controlled clinical trials published in the peer-reviewed literature between 1998 and 2015. Eligible trials also had to be investigating the effect of ER niacin on plasma levels of Lp(a) and include baseline and end of follow-up data sufficient to provide the net change. Dosages ranged from 1,000 to 3,000 mg/day; study durations ranged from 8 to 26 weeks.

Fourteen clinical trials meet the inclusion criteria, comprising 17 treatment arms and 9,013 subjects with heart disease, dyslipidemia or diabetes, of which 5,362 were in niacin treatment arms.

Meta-analysis using random-effects model showed a significant reduction of Lp(a) levels following ER niacin treatment (weighted mean difference – WMD: -22.90%, 95% CI: -27.32, -18.48, P<.001). Results also remained similar when the meta-analysis was repeated with standardized mean difference as summary statistic (WMD: -0.66, 95% CI: -0.82, -0.50, P<.001). Studies using doses less than 2,000mg/day had a WMD of about 22% (WMD: -21.85%, 95% CI: -30.61, -13.10, P<0.001), while studies using 2,000 mg/day or more had a WMD of about 23% (WMD: -23.21%, 95% CI: -28.41, -18.01, P<0.001).

No significant associations between the changes in plasma levels of Lp(a) were found with dose, treatment duration or percentage change in plasma HDL-C levels.

These findings indicate that treatment with extended-release nicotinic acid is associated with a significant reduction in Lp(a) levels in patients  with heart disease, dyslipidemia or diabetes.