Laropiprant plus niacin for dyslipidemia and prevention of cardiovascular disease.
BACKGROUND
Prevention of cardiovascular disease has been only partially successful with the use of cholesterol-lowering drugs like statins. There is a residual risk remaining, which may be addressed by increasing protective high-density lipoprotein (HDL) cholesterol and apolipoprotein A1. The best drug available for that purpose is niacin. In addition to increasing HDL cholesterol and apolipoprotein A1, niacin decreases triglycerides, low-density lipoprotein (LDL)-cholesterol and lipoprotein(a) and has been named the broad-spectrum lipid drug.


METHODS
This review summarizes to what extent a new formulation of niacin may meet this request. The effects of niacin on lipoproteins, atherosclerosis and cardiovascular disease are described, from its first publication in 1955, and also its mechanism of action on lipoproteins and on flushing. The flushing inhibitor laropiprant is described as well as the antiflushing effect of this compound when added to extended-release niacin.


RESULTS
The reader will gain knowledge of the development of niacin as an antiatherosclerosis treatment and of the added value that laropiprant may offer this treatment principle; and also the present place of niacin/laropiprant in the armamentarium of cardiovascular preventive drugs.


CONCLUSIONS
Niacin/laropiprant is a welcome means to address the residual risk in high-risk patients on statin therapy. However, the drug combination cannot completely eliminate niacin-induced side effects. Prescribing this treatment, therefore, will require careful provision of information and instruction to the patient.
Department of Medicine and Health, Linköping University, SE-58183 Linköping, Sweden. anders.olsson@liu.se
Anders G
AG
Olsson
D050197:Atherosclerosis / Q000188:drug therapy; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D004359:Drug Therapy, Combination; D050171:Dyslipidemias / Q000188:drug therapy*; D005483:Flushing / Q000139:chemically induced / Q000517:prevention & control; D006801:Humans; D007211:Indoles / Q000008:administration & dosage* / Q000009:adverse effects; D050356:Lipid Metabolism / Q000187:drug effects; D009525:Niacin / Q000008:administration & dosage* / Q000009:adverse effects / Q000494:pharmacology
D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D007211:Indoles; C518174:MK-0524; D009525:Niacin