In a blinded, exploratory re-review of all possible neurologic occasions by the clinical events committee, three cases of transient ischemic episodes in the niacin group were reclassified as ischemic strokes, but these post hoc reclassifications are not contained in the analyses. Niacin therapy had an identical lack of effect on the composite secondary end point of death from coronary heart disease, non-fatal myocardial infarction, ischemic stroke, or hospitalization for a high-risk acute coronary syndrome and on the composite secondary end point of death from coronary heart disease, non-fatal myocardial infarction, or ischemic stroke . The number of sufferers who died from cardiovascular causes was lower in both the niacin group and the placebo group . There have been no significant interactions with regards to the primary end point between your treatment assignment and prespecified subgroups defined according to age .But how can physicians tell the difference between a typically exhausted teen and one with a significant medical condition? A physical exam can point up huge tonsils or other causes of rest apnea. But Millman said that the most effective diagnostic tool can be a rigorous pediatric sleep history. Doctors, he said, should request patients about insomnia, excessive daytime sleepiness, disordered breathing and other problems. These relevant questions can point up chronic medical or psychiatric conditions that want treatment..