Definition of Evidence Based Medicine by David Sackett:
“integrating individual clinical expertise with the best external evidence”.
I still maintain that my approach to find patients with subclinical CVD by CAC & CIMT and then Rx them to a LDLp less than 750 to 1,000 with low dose combination Rx of statin and Endur-acin or Slo-niacin is the safest, cheapest and best way to reach LDLp goal.
IMPROVE-It with Zetia showed it is all about getting the LDLc as low as possible without side effects. 1,000 mg of Niacin has never been shown to have significant side effects and with a statin has a very good LDLc lowering effect. See Compell trial.
Periodically I try to update the evidence on using Niacin to lower LDLc in combination with statin at low doses. Last time was on Nov 23, 2015
The above paragraph is from Management of Residual Risk after Statin Therapy. Christina Reith, Jane Armitane Atherosclerosis 245 (2016) p 161-170
"Nicotinic acid is the oldest lipid-lowering treatment having been known to affect cholesterol in humans since 1950's."
- Parish S, Tomson J, Wallendszus K, et al. Effects of Extended-Release Niacin with Laropiprant in High-Risk Patients. N Engl J Med. 2014;371(3):203–12. doi:10.1056/NEJMoa1300955. The HPS2-THRIVE trial highlighting the lack of significant benefit in statin responders (LDL < 58 mg/dl on statin therapy) but a significant reduction, in acute cardiovascular events, in partial responders with an LDL >77 mg/dl on statin therapy. The unexpectedly high incidence of adverse effects with niacin-laropiprant can at least partially be ascribed to laropiprant.PubMedCrossRef