Abstract 

Objective

High-density lipoprotein cholesterol (HDL-C) concentration is a strong predictor of cardiovascular events in both naïve and statin-treated patients. Nicotinic acid is an attractive option for decreasing residual risk in statin-treated or statin-intolerant patients since it increases HDL-C by up to 20% and decreases low-density lipoprotein cholesterol and lipoprotein(a) plasma concentrations.

Methods

We performed a computerized PubMed literature search that focused on clinical trials evaluating niacin, alone or in combination with other lipid-lowering drugs, published between January 1966 and August 2008.

Results

Among 587 citations, 29 full articles were read and 14 were eligible for inclusion. Overall 11 randomized controlled trials enrolled 2682 patients in the active group and 3934 in the control group. In primary analysis, niacin significantly reduced major coronary events (relative odds reduction 25%, stroke 26%,and any cardiovascular events 27%). Except for stroke, the pooled between-group difference remained significant in sensitivity analysis excluding the largest trial. In comparison with the non-niacin group, more patients in the niacin group had regression of coronary atherosclerosis >92% whereas the rate of patients with progression decreased by 41%,. Similar effects of niacin were found on carotid intima thickness with a weighted mean difference in annual change of −17

Conclusions

Although the studies were conducted before statin therapy become standard care, and mostly in patients in secondary prevention, with various dosages of nicotinic acid 1–3 g/day, this meta-analysis found positive effects of niacin alone or in combination on all cardiovascular events and on atherosclerosis evolution.

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Nicotinamide, also known as niacinamide and nicotinic acid amide, is the amide of nicotinic acid (vitamin B₃ / niacin). Nicotinamide is a water-soluble vitamin and is part of the vitamin B group. Nicotinic acid, also known as niacin, is converted to nicotinamide in vivo, and, though the two are identical in their vitamin functions, nicotinamide does not have the same pharmacologic and toxic effects of niacin, which occur incidental to niacin's conversion. Thus nicotinamide does not reduce cholesterol or cause flushing,^[1] although nicotinamide may be toxic to the liver at doses exceeding 3 g/day for adults.^[  Wikipedia—article is skeptical about effectiveness of  inisotol and Nicotinamide.