Effects of Extended-Release Niacin With Laropiprant in High-Risk Patients (HPS2-THRIVE)

HPS2-THRIVE was the large trial that, alongside AIM-HIGH, effectively ended niacin’s role in cardiovascular prevention — and it did so emphatically.

In over 25,000 high-risk patients on statin therapy, adding extended-release niacin (with laropiprant to reduce flushing) produced no significant reduction in major vascular events. Worse, it increased serious adverse events — more diabetes, more infections, more bleeding. The drug not only failed to help; it caused measurable harm.

Combined with AIM-HIGH, this trial closed the book on niacin as add-on therapy and dealt another blow to the “raise HDL to prevent events” hypothesis. Favorable changes in HDL and triglycerides again failed to translate into benefit, while real toxicity emerged.

We rate the evidence very strong. A large, rigorous, placebo-controlled randomized trial, its decisive negative-and-harmful result reshaped guidelines and reinforced that altering lipid numbers is no substitute for proven outcome benefit.