The AIM-HIGH trial investigated whether extended-release niacin added to intensive statin therapy reduced cardiovascular risk in patients with atherosclerotic cardiovascular disease and low HDL cholesterol levels. A total of 3414 patients were randomly assigned to receive niacin (1718) or placebo (1696). The primary endpoint was the first occurrence of death from coronary heart disease, nonfatal myocardial infarction, ischemic stroke, hospitalization for acute coronary syndrome, or symptom-driven revascularization. After a mean follow-up of 3 years, the primary endpoint occurred in 282 patients in the niacin group (16.4%) and 274 in the placebo group (16.2%), with no significant difference between the groups (hazard ratio, 1.02; 95% CI, 0.87 to 1.21; P=0.79). Niacin significantly increased HDL cholesterol levels and reduced triglyceride and LDL cholesterol levels. However, there was no significant reduction in the primary composite endpoint of cardiovascular events. The trial was stopped early due to lack of efficacy. The study found no incremental clinical benefit from adding niacin to statin therapy in patients with low HDL cholesterol levels and LDL cholesterol levels below 70 mg per deciliter. The results suggest that niacin does not provide additional cardiovascular benefits in these patients. The study was funded by the National Heart, Lung, and Blood Institute and Abbott Laboratories. The findings indicate that niacin may not be effective in reducing cardiovascular events in patients with established cardiovascular disease and low HDL cholesterol levels, despite improvements in lipid profiles. The study highlights the importance of statins in reducing cardiovascular risk and the need for further research into other lipid-modifying therapies. The trial had limitations, including a low percentage of women and ethnic minorities, and the possibility that the follow-up period was not long enough to show a clinical effect of niacin. The study underscores the need for further research into the effectiveness of niacin and other lipid-modifying therapies in patients with cardiovascular disease.The AIM-HIGH trial investigated whether extended-release niacin added to intensive statin therapy reduced cardiovascular risk in patients with atherosclerotic cardiovascular disease and low HDL cholesterol levels. A total of 3414 patients were randomly assigned to receive niacin (1718) or placebo (1696). The primary endpoint was the first occurrence of death from coronary heart disease, nonfatal myocardial infarction, ischemic stroke, hospitalization for acute coronary syndrome, or symptom-driven revascularization. After a mean follow-up of 3 years, the primary endpoint occurred in 282 patients in the niacin group (16.4%) and 274 in the placebo group (16.2%), with no significant difference between the groups (hazard ratio, 1.02; 95% CI, 0.87 to 1.21; P=0.79). Niacin significantly increased HDL cholesterol levels and reduced triglyceride and LDL cholesterol levels. However, there was no significant reduction in the primary composite endpoint of cardiovascular events. The trial was stopped early due to lack of efficacy. The study found no incremental clinical benefit from adding niacin to statin therapy in patients with low HDL cholesterol levels and LDL cholesterol levels below 70 mg per deciliter. The results suggest that niacin does not provide additional cardiovascular benefits in these patients. The study was funded by the National Heart, Lung, and Blood Institute and Abbott Laboratories. The findings indicate that niacin may not be effective in reducing cardiovascular events in patients with established cardiovascular disease and low HDL cholesterol levels, despite improvements in lipid profiles. The study highlights the importance of statins in reducing cardiovascular risk and the need for further research into other lipid-modifying therapies. The trial had limitations, including a low percentage of women and ethnic minorities, and the possibility that the follow-up period was not long enough to show a clinical effect of niacin. The study underscores the need for further research into the effectiveness of niacin and other lipid-modifying therapies in patients with cardiovascular disease.