title: Extended-release niacin acutely suppresses postprandial triglyceridemia.
abstract: OBJECTIVE
  Postprandial triglyceridemia predicts cardiovascular events. Niacin might lower postprandial triglycerides by restricting free fatty acids. Immediate-release niacin reduced postprandial triglycerides, but extended-release niacin failed to do so when dosed the night before a fat challenge. The study aims were to determine whether extended-release niacin dosed before a fat challenge suppresses postprandial triglycerides and whether postprandial triglycerides are related to free fatty acid restriction.
  
  
  METHODS
  A double-blinded, placebo-controlled, random-order crossover experiment was performed, in which healthy volunteers took 2 g extended-release niacin or placebo 1 hour before heavy cream. We sampled blood over 12 hours and report triglycerides and free fatty acid as means ± standard deviation for incremental area under the curve (AUC) and nadir.
  
  
  RESULTS
  By combining 43 fat challenges from 22 subjects, postprandial triglycerides incremental AUC was +312 ± 200 mg/dL*h on placebo versus +199 ± 200 mg/dL*h on extended-release niacin (33% decrease, P=.02). The incremental nadir for free fatty acid was -0.07 ± 0.15 mmol/L on placebo versus -0.27 ± 0.13 mmol/L on extended-release niacin (P<.0001), and free fatty acid incremental AUC decreased from +2.9 ± 1.5 mmol/L*h to +1.5 ± 1.5 mmol/L*h on extended-release niacin (20% decrease, P=.0015). The incremental AUC for triglycerides was strongly related to the post-dose decrease in free fatty acid (r = +0.58, P=.0007).
  
  
  CONCLUSIONS
  Given right before a fat meal, even a single dose of extended-release niacin suppresses postprandial triglyceridemia. This establishes that postprandial triglycerides suppression is an acute pharmacodynamic effect of extended-release niacin, probably the result of marked free fatty acid restriction. Further study is warranted to determine whether mealtime dosing would augment the clinical efficacy of extended-release niacin therapy.
authors: Department of Medicine, Division of Translational Medicine and Human Genetics, Perelman School of Medicine at the University of Pennsylvania, and the University of Pennsylvania Health System, Philadelphia, PA 19104, USA.
authors: M Haris U
authors: MH
authors: Usman
authors: Arman
authors: A
authors: Qamar
authors: Ramprasad
authors: R
authors: Gadi
authors: Scott
authors: S
authors: Lilly
authors: Harsh
authors: H
authors: Goel
authors: Jaison
authors: J
authors: Hampson
authors: Megan L
authors: ML
authors: Mucksavage
authors: Grace A
authors: GA
authors: Nathanson
authors: Daniel J
authors: DJ
authors: Rader
authors: Richard L
authors: RL
authors: Dunbar
mesh_terms: D001741:Black or African American; D015415:Biomarkers / Q000097:blood; D018592:Cross-Over Studies; D003692:Delayed-Action Preparations; D004311:Double-Blind Method; D005230:Fatty Acids, Nonesterified / Q000097:blood; D006801:Humans; D015228:Hypertriglyceridemia / Q000097:blood / Q000208:ethnology / Q000517:prevention & control*; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D009525:Niacin / Q000627:therapeutic use*; D019518:Postprandial Period; D012372:ROC Curve; D012044:Regression Analysis; D016896:Treatment Outcome; D014280:Triglycerides / Q000097:blood
chemical_list: D015415:Biomarkers; D003692:Delayed-Action Preparations; D005230:Fatty Acids, Nonesterified; D000960:Hypolipidemic Agents; D014280:Triglycerides; D009525:Niacin