Authors
Crouse JR 3rd.
Institution
Bowman Gray School of Medicine, Winston Salem, North Carolina 27157, USA.
Title
New developments in the
use of niacin for treatment of
hyperlipidemia: new considerations in the
use of an old drug. [Review] [47 refs]
Source
Coronary Artery Disease. 7(4):321-6, 1996 Apr.
Abstract
Niacin has been used for many years to
treat hyperlipidemia. It has been shown to reduce coronary death and
non-fatal myocardial infarction and, in a separate analysis of long-term
(15-year) follow-up, all cause mortality. It reduces total
cholesterol, low density lipoprotein cholesterol (LDL-C) and triglycerides
and increases high density lipoprotein cholesterol (HDL-C). Sustained-release
niacin may be associated with more dramatic changes in LDL-C
and triglyceride, whereas the short acting preparation
causes greater increases in HDL-C. The
increase of HDL-C occurs at a lower dose (1500 mg/day) than
the reduction of LDL-C (> 1500 mg/day).
Niacin also favorably influences other
lipid parameters including lipoprotein(a) [Lp(a)], alimentary lipemia,
familial defective apolipoprotein B-100 and small dense LDL. Combination of
niacin with a bile acid sequestrant or a reductase inhibitor
represents a powerful lipid-altering regimen. Whereas the
reductase inhibitors and bile acid binding resins primarily affect LDL-C,
the combined therapy has a synergistic
effect to reduce LDL-C and, in addition, the
niacin reduces triglycerides and increases HDL-C.
The major drawback in the
use of niacin is associated side effects
(flushing and palpitations) and toxicity (worsening of diabetes control,
exacerbation of peptic ulcer disease, gout, hepatitis).
Niacin has a long history of use as a lipid
lowering agent and has several attractive features. Unfortunately,
the side effect profile of this agent warrants its
use only in patients with marked dyslipidemia in whom side
effects and potential toxicity are closely monitored. [References: 47]