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Physicians sometimes prescribe niacin for statin-treated patients to raise HDL cholesterol levels or to manipulate lipid subfractions detected by more elaborate lipid testing. However, the clinical effect of this practice is unclear. In the NIH-sponsored AIM-HIGH study, 3414 patients with established cardiovascular disease were randomized to receive simvastatin plus either extended-release niacin or placebo. Enrollment criteria included HDL cholesterol levels <40 mg/dL for men and <50 mg/dL for women, and triglyceride levels between 150 and 400 mg/dL. Patients were selected for randomization only after completing an open-label run-in phase, during which they demonstrated that they could tolerate high niacin doses (1500–2000 mg daily). Durin…