Chicago Medical School and Affiliated Hospitals, Rosalind Franklin University of Medicine & Science, North Chicago, IL, USA.
J Cardiovasc Pharmacol Ther. 2010 Jun;15(2):158-66. doi: 10.1177/1074248410361337. Epub 2010 Mar 5.
Niacin or nicotinic acid (vitamin B3) raises the levels of high-density lipoprotein cholesterol (HDL) by about 30% to 35%. In patients with prior coronary disease, 7 trials have been published on clinical cardiovascular disease outcomes and the results, not surprisingly, are inconsistent. Hence, we performed this meta-analysis of randomized placebo-controlled trials (RCTs) to evaluate the effect of niacin on cardiovascular outcomes in patients with coronary artery disease.
A systematic search using PubMed, EMBASE, and Cochrane library databases was performed. Seven studies with a total of 5137 patients met our inclusion criteria. Heterogeneity of the studies was analyzed by the Cochran Q statistics. The significance of common treatment effect was assessed by computing the combined relative risks using the Mantel-Haenszel fixed-effect model. A 2-sided alpha error of less than .05 was considered statistically significant (P < .05).
Compared to placebo group, niacin therapy significantly reduced coronary artery revascularization (RR [relative risk]: 0.307 with 95% CI: 0.150-0.628; P = .001), nonfatal myocardial infarction ([MI]; RR: 0.719; 95% CI: 0.603-0.856; P = .000), stroke, and TIA ([transient ischemic attack] RR: 0.759; 95%CI: 0.613-0.940; P = .012), as well as a possible but nonsignificant decrease in cardiac mortality (RR: 0.883: 95% CI: 0.773-1.008; p= 0.066).
In a meta-analysis of seven trials of secondary prevention, niacin was associated with a significant reduction in cardiovascular events and possible small but non-significant decreases in coronary and cardiovascular mortality.
烟酸或烟酰胺（维生素 B3）可将高密度脂蛋白胆固醇（HDL）水平提高约 30%至 35%。在既往患有冠心病的患者中，已有 7 项临床试验发表了关于临床心血管疾病结局的结果，这些结果并不令人意外，并不一致。因此，我们进行了这项荟萃分析，以评估烟酸对冠心病患者心血管结局的影响。
使用 PubMed、EMBASE 和 Cochrane 图书馆数据库进行系统搜索。共有 7 项研究，总计 5137 名患者符合我们的纳入标准。通过 Cochran Q 统计量分析研究的异质性。使用 Mantel-Haenszel 固定效应模型计算合并相对风险来评估共同治疗效果的显著性。双侧 α 误差小于 0.05 被认为具有统计学意义（P<0.05）。
与安慰剂组相比，烟酸治疗组显著降低了冠状动脉血运重建（RR[相对风险]：0.307，95%CI：0.150-0.628；P=0.001）、非致死性心肌梗死（RR：0.719；95%CI：0.603-0.856；P=0.000）、卒中和 TIA（RR：0.759；95%CI：0.613-0.940；P=0.012），以及可能但无统计学意义的心脏死亡率降低（RR：0.883：95%CI：0.773-1.008；P=0.066）。
在 7 项二级预防试验的荟萃分析中，烟酸与心血管事件的显著减少相关，可能与冠状动脉和心血管死亡率的微小但无统计学意义的降低有关。
