"Niacin has always been known as a drug that’s not easy to use, one with lots of side effects. It’s never been a first- or second-line therapy. It’s always been the drug where, when you can’t get there any other way, then you use it," observed Dr. Ballantyne, professor of medicine and chief of cardiology at Baylor College of Medicine, Houston.
Dr. Spencer B. King III called HPS2-THRIVE "another nail in the coffin for niacin," coming after the negative results of the National Institutes of Health–sponsored AIM-HIGH (Niacin Plus Statin to Prevent Vascular Events) study.
"I think the practice-changing part of this study is that many of us have been piling on a lot of niacin in people with low HDL. What you’ve shown is going to change attitudes among many physicians," predicted Dr. King, president of the Saint Joseph’s Heart and Vascular Institute, Atlanta.
Dr. Rory Collins
When he asked Dr. Armitage whether any room remains now for individualized niacin therapy in selected patients, she replied that the investigators couldn’t identify any patient subgroup in whom the benefit outweighed the greater risk.
Dr. Rory Collins, chair of the HPS2-THRIVE trial, chimed in, adding: "Is niacin dead? I think in the light of these findings, it’s not healthy. The default position should change. It should be, Is there a good reason for using this therapy in any particular patient when there are additional ways, besides statins, of lowering LDL cholesterol, and where we don’t as yet have evidence that raising HDL cholesterol produces benefit?"
The HPS2-THRIVE trial was funded by Merck. Dr. Armitage, Dr. Collins, Dr. Arnett, and Dr. King reported having no relevant financial conflicts. Dr. Ballantyne serves as a consultant to numerous pharmaceutical companies, including Merck.
