The class
Meta-analysis of 69,515 patients finds niacin and CETP inhibitors do not reduce cardiovascular mortality (Nutr Metab Cardiovasc Dis 2015)
Original title: Effects of HDL-modifiers on cardiovascular outcomes: a meta-analysis of randomized trials
This meta-analysis of 18 randomized trials (69,515 patients) compared HDL-raising treatment with niacin or CETP inhibitors against optimal medical therapy for cardiovascular outcomes. HDL-modifying treatment did not reduce cardiovascular mortality (2.3% versus 3.4%; odds ratio 0.96, 95% CI, 0.87-1.05, p = 0.37), regardless of baseline patient risk profile or the amount of HDL increase achieved. Niacin, but not CETP inhibitors, reduced myocardial infarction and coronary revascularization, while HDL-modifiers overall carried a higher rate of serious adverse events (odds ratio 1.24, 95% CI, 1.18-1.31, p < 0.00001), including new-onset diabetes with niacin and worsening hypertension with CETP inhibitors.
Original abstract
Background And Aim: High density lipoproteins (HDL) have been addressed as a potential strategy for cardiovascular prevention, with great controversies on pharmacological approaches for HDL-elevation. Our aim was to compare HDL-rising treatment with niacin or CETP-inhibitors with optimal medical therapy in cardiovascular outcome.
Methods And Results: Randomized trials were searched. Primary endpoint was cardiovascular death, secondary were: non fatal myocardial infarction; coronary revascularization; cerebrovascular accidents and safety endpoints. As many as 18 randomized trials, for a total of 69,515 patients, were included. HDL-modifiers did not reduce cardiovascular mortality (2.3%vs3.4%; OR [95%CI] = 0.96 [0.87-1.05], p = 0.37, phet = 0.58), with no benefit from niacin/CETP inhibitors according to patients' risk profile (beta [95%CI] = -0.14 [-0.29 to 0.02], p = 0.09) or the amount of HDL increase (beta [95%CI] = 0.014 [-0.008 to 0.04], p = 0.21). Niacin but not CETP-I reduced myocardial infarction and coronary revascularization, but higher rate of SAE occurred with HDL-modifiers (OR [95%CI] = 1.24 [1.18-1.31], p < 0.00001, phet = 0.02), in particular new onset of diabetes with niacin and worsening of hypertension with CETP-inhibitors.
Conclusions: Niacin and CETP inhibitors do not influence cardiovascular mortality. Significant benefits in MI and coronary revascularization were observed with niacin, despite the higher occurrence of diabetes.
Summary written by cetpinhibition.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.