We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Comment & Response |

Role of Nicotinic Acid in Atherosclerosis Prevention—Reply

Cynthia A. Jackevicius, BScPhm, PharmD, MSc, BCPS1,2,3,4,5; Harlan M. Krumholz, MD, SM6,7,8,9
[+] Author Affiliations
1Department of Pharmacy Practice and Administration, College of Pharmacy, Western University of Health Sciences, Pomona, California
2Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
3Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
4Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
5University Health Network, Toronto, Canada
6Department of Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
7Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
8Department of Epidemiology and Public Health, Section of Health Policy and Administration, New Haven, Connecticut
9Robert Wood Johnson Clinical Scholars Program, New Haven, Connecticut
JAMA Intern Med. 2014;174(4):649. doi:10.1001/jamainternmed.2013.12811.
Text Size: A A A
Published online


In Reply Dr Whayne suggests that “there is ample support to use nicotinic acid” when low-density lipoprotein cholesterol and high-density lipoprotein cholesterol targets have not been reached by citing the Coronary Drug Project, the Cholesterol Lowering Atherosclerosis Study, and a recent meta-analysis.13 As cited by Dr Whayne, some of the strongest evidence for niacin comes from the secondary prevention Coronary Drug Project trial. However, it is perhaps not as strong as some may recall. It is often forgotten that niacin actually failed to demonstrate a significant reduction in the trial’s primary end point of total mortality at 5 years compared with placebo in the post–myocardial infarction population studied, although it significantly reduced the secondary end point of nonfatal MI and cardiac death.4 A significant reduction in mortality only appeared after 15 years of follow-up with a greater time off niacin therapy than receiving it (6.2 years taking niacin and 8.8 years after stopping niacin therapy).1 In the most recent of many niacin meta-analyses cited by Dr Whayne, because many heterogenous niacin trials were pooled and niacin was primarily combined with other lipid-lowering agents, it fails to isolate and confirm a benefit of niacin itself.3 Furthermore, without the inclusion of HPS-2-THRIVE (Heart Protection Study 2–Treatment of HDL to Reduce the Incidence of Vascular Events), this latest meta-analysis remains an incomplete reflection of the totality of niacin evidence to date.3,5


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





April 1, 2014
Thomas F. Whayne Jr, MD, PhD
1Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington
JAMA Intern Med. 2014;174(4):648-649. doi:10.1001/jamainternmed.2013.12651.
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...