What is the comparative effectiveness of a high-dose statin plus ezetimibe, a high-dose statin plus PCSK9 inhibitor, and a high-dose statin plus ezetimibe plus PCSK9 inhibitor (triple therapy) on important CV outcomes in higher risk patients?
In a fair quality systematic review of five randomized controlled trials (RCTs) in a mix of primary and secondary prevention patients (n=32,966) who used supplements containing therapeutic doses of niacin (2-3 grams/day), Schandelmaier et al. (2017) noted no benefits and increased harms. This systematic review noted no difference in cardiovascular mortality, all-cause mortality, non-fatal myocardial infarction, or stroke. However, side effects resulted in significant flushing, pruritus, gastrointestinal symptoms, new-onset diabetes mellitus, and more discontinuations.