This study was designed to determine whether there is incremental clinical benefit of niacin in reducing cardiovascular events in patients who have attained optimal on-treatment levels of low-density lipoprotein cholesterol (LDL-C) with a statin.Methods
- Between 2006 and 2010, 8,162 individuals signed consent to be screened, 4,275 began study drug run-in, and 3,414 were randomized to treatment.
- Mean age at entry was 64 ± 9 years, 85% were men, and 92% were white.
- All study participants had established CV disease and atherogenic dyslipidemia.
- Participants received simvastatin (or simvastatin plus ezetimibe) at a dose sufficient to maintain LDL-C at 40 - 80 mg/dL (1.03-2.07 mmol/L) and were randomized to receive extended-release niacin or matching placebo.
- The primary end point is time to the first occurrence of coronary heart disease death, nonfatal myocardial infarction, ischemic stroke, hospitalization for acute coronary syndrome or symptom-driven coronary or cerebral revascularization with average follow-up of 4.1 years.
- Risk factors were prevalent with 34% having diabetes; 71%, hypertension; and 81%, metabolic syndrome.
- Most participants had coronary artery disease (92%), whereas 11% had peripheral arterial disease; and 12%, cerebrovascular disease.
- Previous coronary revascularization occurred in 82%, and 54% reported a prior myocardial infarction.
- Among participants on a statin at entry (94%), mean baseline LDL-C was 71 mg/dL (1.84 mmol/L); mean high-density lipoprotein cholesterol (HDL-C), 34.9 mg/dL (0.90 mmol/L); and median triglycerides, 161 mg/dL (1.82 mmol/L).