The metabolic syndrome: pathophysiology, clinical relevance, and use of niacin.
OBJECTIVE
To review the pathophysiology and clinical relevance for using niacin to treat the metabolic syndrome.


METHODS
Primary articles were identified through a MEDLINE search (1966-January 2003), and recommendations for treatment were obtained from the National Cholesterol Education Program Adult Treatment Panel (NCEP-ATP) III guidelines.


METHODS
Published studies showing the effects of the metabolic syndrome, atherogenic dyslipidemia, and niacin were evaluated and reviewed.


RESULTS
The metabolic syndrome is a highly prevalent condition that affects 24% of American adults and significantly increases the risk of coronary heart disease (CHD). Most patients with metabolic syndrome have atherogenic dyslipidemia characterized by elevated triglycerides, low high-density-lipoprotein cholesterol (HDL-C), and small, dense low-density-lipoprotein cholesterol (LDL-C) particles. The NCEP-ATP III identifies patients with the metabolic syndrome as candidates for intensified therapy. Lifestyle modifications and drug therapy are recommended. Niacin represents a good option for treating the triad of lipid abnormalities seen in the metabolic syndrome because it raises HDL-C, lowers triglycerides, and increases LDL-C particle size.


CONCLUSIONS
Treatment of the metabolic syndrome is recommended by NCEP-ATP III to further reduce CHD risk after the LDL-C target has been met. Prospective clinical studies are needed to define the impact of niacin and other lipid-modifying agents on CHD morbidity and mortality in patients with the metabolic syndrome.
Ito
Matthew K
MK
Thomas J Long School of Pharmacy and Health Sciences, University of the Pacific, Stockton, CA, USA. uopito@aol.com
D000328:Adult; D000368:Aged; D002784:Cholesterol / Q000097:blood*; D003327:Coronary Disease / Q000188:drug therapy / Q000209:etiology / Q000401:mortality; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology; D008875:Middle Aged; D009525:Niacin / Q000627:therapeutic use*; D015995:Prevalence; D012307:Risk Factors; D014280:Triglycerides / Q000097:blood
D000960:Hypolipidemic Agents; D014280:Triglycerides; D009525:Niacin; D002784:Cholesterol