title: Niacin: another look at an underutilized lipid-lowering medication.
abstract: Niacin, or water-soluble vitamin B(3), when given at pharmacologic doses, is a powerful lipid-altering agent. This drug, which lowers the levels of atherogenic, apolipoprotein-B-containing lipoproteins, is one of few medications that can raise the levels of atheroprotective HDL cholesterol. Niacin also has beneficial effects on other cardiovascular risk factors, including lipoprotein(a), C-reactive protein, platelet-activating factor acetylhydrolase, plasminogen activator inhibitor 1 and fibrinogen. Many clinical trials have confirmed the lipid effects of niacin treatment; however, its effects on cardiovascular outcomes have been called into question owing to the AIM-HIGH trial, which showed no benefit of niacin therapy on cardiovascular endpoints. Furthermore, use of niacin has historically been limited by tolerability issues. In addition to flushing, worsened hyperglycaemia among patients with diabetes mellitus has also been a concern with niacin therapy. This article reviews the utility of niacin including its mechanism of action, clinical trial data regarding cardiovascular outcomes, adverse effect profile and strategies to address these effects and improve compliance.
authors.affiliation: Robarts Research Institute and Schulich School of Medicine and Dentistry, University of the Western Ontario, 100 Perth Drive, N6A 5K8 London, Ontario, Canada.
authors.forename: Julia C
authors.initials: JC
authors.lastname: Creider
authors.forename: Robert A
authors.initials: RA
authors.lastname: Hegele
authors.forename: Tisha R
authors.initials: TR
authors.lastname: Joy
mesh_terms: D002318:Cardiovascular Diseases / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D002626:Chemistry, Pharmaceutical; D008076:Cholesterol, HDL / Q000097:blood; D002986:Clinical Trials as Topic / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D008297:Male; D008954:Models, Biological; D009525:Niacin / Q000627:therapeutic use*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*
chemical_list: D008076:Cholesterol, HDL; D000960:Hypolipidemic Agents; D009525:Niacin