Niacin and Risk of New-Onset Diabetes

Study Questions:

Does niacin therapy increase the risk for diabetes?

Methods:

This was a meta-analysis of trials published from 1975 to 2014. Trials had to be primarily designed to examine the effects of niacin, with outcomes including cardiovascular endpoints and/or cardiovascular surrogate markers. Searches of Medline, EMBASE, and Cochrane Central Register of Controlled Trials were completed. Trials were included if they had ≥50 participants without diabetes and included an average follow-up of ≥24 weeks. The primary outcome of interest was new-onset diabetes. The majority of publications were excluded for being noncardiovascular related, post-hoc analyses, not a randomized controlled trial study design, and follow-up <24 weeks.

Results:

Of the 1,163 publications identified, 1,158 abstracts were reviewed, 66 full-text articles were reviewed, and 11 trials were included in this meta-analysis. These 11 trials included a total of 26,340 participants without diabetes at entry. Over a mean follow-up of 3.6 years, 1,371 (5.3%) developed diabetes (725 randomized to niacin, and 646 randomized to a control condition). Niacin was associated with an increased risk for diabetes (relative risk, 1.34; 95% confidence interval [CI], 1.21-1.49). Limited heterogeneity between trials was observed (I2 = 0.0%, p = 0.87). The authors estimated that this risk equates to one additional case of diabetes per 43 patients treated with niacin for 5 years (95% CI, 30-70). No interaction was noted with statin therapy or with laropiprant therapy.

Conclusions:

The investigators concluded that niacin therapy was associated with a modest increase in developing diabetes.

Perspective:

These data suggest that there is an increased risk of diabetes associated with niacin use. Given that trials over recent years have not observed cardiovascular benefit related to niacin, the risk/benefit assessment for niacin use suggests that a majority of patients should not be using niacin at this time.

Clinical Topics: Clinical Topic Collection: Dyslipidemia, Prevention, Nonstatins, Novel Agents, Statins

Keywords: Biological Markers, Diabetes Mellitus, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Niacin, Primary Prevention, Risk, Risk Assessment


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