niacin and cardiovascular disease

Doug Skrecky (
Mon, 23 Nov 1998 23:40:34 -0800 (PST)

Crouse JR 3rd.
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]