Therapy
Extended-release niacin lowers Lp(a) by about 23% regardless of dose, a meta-analysis of 14 trials and 9013 patients (Metabolism 2016)
Original title: Effect of extended-release niacin on plasma lipoprotein(a) levels: A systematic review and meta-analysis of randomized placebo-controlled trials
This meta-analysis and meta-regression pooled 14 randomised placebo-controlled trials, published between 1998 and 2015, comprising 17 treatment arms and 9013 subjects (5362 on niacin), to quantify extended-release nicotinic acid Lp(a)-lowering effect. Meta-analysis showed a significant Lp(a) reduction with niacin (weighted mean difference -22.90%, 95% CI -27.32 to -18.48, P<0.001), consistent whether standardised mean difference was used instead (-0.66, 95% CI -0.82 to -0.50, P<0.001). The effect was comparable at doses below 2000 mg/day (-21.85%, 95% CI -30.61 to -13.10, P<0.001) and at or above 2000 mg/day (-23.21%, 95% CI -28.41 to -18.01, P<0.001), with meta-regression finding no significant association between the effect and dose (P=0.983), treatment duration (P=0.166), or HDL cholesterol change (P=0.350). The findings confirm extended-release niacin significantly reduces Lp(a), an effect independent of dose.
Original abstract
Aim: Lipoprotein(a) (Lp(a)) is a proatherogenic and prothrombotic lipoprotein. Our aim was to quantify the extended-release nicotinic acid Lp(a) reducing effect with a meta-analysis of the available randomized clinical trials.
Methods: A meta-analysis and random-effects meta-regression were performed on data pooled from 14 randomized placebo-controlled clinical trials published between 1998 and 2015, comprising 17 treatment arms, which included 9013 subjects, with 5362 in the niacin arm.
Results: The impact of ER niacin on plasma Lp(a) concentrations was reported in 17 treatment arms. Meta-analysis suggested a significant reduction of Lp(a) levels following ER niacin treatment (weighted mean difference - WMD: -22.90%, 95% CI: -27.32, -18.48, p<0.001). Results also remained similar when the meta-analysis was repeated with standardized mean difference as summary statistic (WMD: -0.66, 95% CI: -0.82, -0.50, p<0.001). When the studies were categorized according to the administered dose, there was a comparable effect between the subsets of studies with administered doses of <2000mg/day (WMD: -21.85%, 95% CI: -30.61, -13.10, p<0.001) and ≥2000mg/day (WMD: -23.21%, 95% CI: -28.41, -18.01, p<0.001). The results of the random-effects meta-regression did not suggest any significant association between the changes in plasma concentrations of Lp(a) with dose (slope: -0.0001; 95% CI: -0.01, 0.01; p=0.983), treatment duration (slope: -0.40; 95% CI: -0.97, 0.17; p=0.166), and percentage change in plasma HDL-C concentrations (slope: 0.44; 95% CI: -0.48, 1.36; p=0.350).
Conclusion: In this meta-analysis of randomized placebo-controlled clinical trials, treatment with nicotinic acid was associated with a significant reduction in Lp(a) levels.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.