Niacin
HDL and LDL as therapeutic targets for cardiovascular disease prevention: the possible role of niacin.
Olsson AG.
Nutr Metab Cardiovasc Dis. 2010 Oct;20(8):553-7
Recently two studies on the effect of addition of extended-release niacin to statin treatment on measures of carotid atherosclerosis were estimated in the ARBITER 6-HALTS study (Arterial Biology for the Investigation of the Treatment Effects of Reducing Cholesterol 6-HDL and LDL Treatment Strategies) study and the Oxford Niacin Study were published. Adding niacin to statin treatment significantly diminished carotid atherosclerosis as measured by ultrasound carotid intima-media thickness or magnetic resonance imaging. An inhibitor of niacin induced flushing, laropiprant has been developed and demonstrated to considerably improve the tolerability of niacin therapy without impeding on its effect on lipoproteins. Still however clear evidence for the clinical benefit of long-term niacin treatment on cardiovascular morbidity and mortality is lacking. The development situation for ezetimibe is similar to that of niacin. Long-term interventional studies with hard endpoints of both therapies are ongoing. Also both drugs, when proven efficient and safe, are eagerly needed in the prevention of cardiovascular disease. PMID: 20739153
Copyright © 2010 Elsevier B.V. All rights reserved.
What does the future hold for niacin as a treatment for hyperlipidaemia and cardiovascular disease?
Ahmed MH.
J Cardiovasc Med (Hagerstown). 2010 Nov;11(11):858-60.
Statin therapy is widely used in treatment and prevention of cardiovascular disease (CVD). It is well established that statin therapy is not associated with significant increase in high-density lipoprotein cholesterol (HDL-c) or significant decrease in triglyceride level. Importantly, emerging evidence has suggested that low HDL-c and high triglyceride are strong risk factors associated with CVD. Niacin is a unique lipid-lowering medication with a capacity to lower low-density lipoprotein cholesterol (LDL-c), triglyceride and increase HDL-c. In this context, there is considerable interest in trials involving niacin as monotherapy and in association with statins. Recent trials showed that the combination of statin and niacin is an effective treatment not only for dyslipidaemia (high LDL-c, high triglyceride and low HDL-c) but also for carotid intima-media thickness, one of the important features of atherosclerosis. Furthermore, niacin is distinguished by its unique capacity to effectively lower lipoprotein (a) [Lp(a)] levels. Flushing is the only factor that limits the wide use of niacin. The combination of statin and niacin has potential as a future treatment of atherogenic dyslipidemias; however, further evidence is needed. Importantly, the impact of niacin and statin on insulin sensitivity is not yet known. This article projects the potential benefits of current and possible future niacin clinical trials. PMID: 20686417
Niacin: from mechanisms of action to therapeutic uses.
Al-Mohaissen MA, Pun SC, Frohlich JJ.
Mini Rev Med Chem. 2010 Mar;10(3):204-17.
Niacin has broad spectrum lipid modifying and anti-atherosclerotic properties. It is the most effective medication available for raising raise high density lipoprotein (HDL) levels. Despite statin therapy there remains a considerable residual cardiovascular risk attributed to low HDL levels. Currently, statins decrease cardiovascular events and death by about 25-40%. Trials with surrogate endpoints have shown a decrease in endpoints by 60-90% when a combination of statin and niacin has been used. There is a growing interest in niacin in combination therapy to fill the treatment gap by modifying lipid parameters other than low density lipoprotein cholesterol. This review addresses the role of niacin in comprehensive lipid management with an emphasis on its mechanism of action, formulations, side effects, evidence from clinical trials and also focuses on practical issues related to niacin therapy. PMID: 20167004