title: Niacin in the Treatment of Hyperlipidemias in Light of New Clinical Trials: Has Niacin Lost its Place?
abstract: Niacin is considered to be a powerful drug for the treatment of lipid and lipoprotein abnormalities connected with "residual cardiovascular risk", which persist in high-risk patients even when the target goals of LDL-C are achieved with statin therapy. Recent large randomized clinical studies - AIM-HIGH (Atherothrombosis Intervention in Metabolic Syndrome With Low HDL/High Triglycerides) and HPS2-THRIVE (Heart Protection Study 2-Treatment of HDL to Reduce the Incidence of Vascular Events) - delivered some disappointing results, leading to the conclusion that no further benefit (decreased parameters of cardiovascular risk) is achieved by adding niacin to existing statin therapy in patients with high cardiovascular risk. Moreover, in these studies, several adverse effects of the treatment were observed; therefore, niacin treatment for hypolipidemias is not recommended. In this paper, we analyze the mechanisms underlying the hypolipidemic and antiatherogenic effects of niacin as well as some limitations of the designs of the AIM HIGH and HP2-THRIVE studies. We also provide the possibilities of rational usage of niacin for specific types of dyslipidemias.
authors.affiliation: 4th Department of Medicine, 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.
authors.forename: Miroslav
authors.initials: M
authors.lastname: Zeman
authors.affiliation: 4th Department of Medicine, 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.
authors.forename: Marek
authors.initials: M
authors.lastname: Vecka
authors.affiliation: Institute of Pharmacology, 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.
authors.forename: František
authors.initials: F
authors.lastname: Perlík
authors.affiliation: Research and Development Center, C2P s.r.o., Chlumec nad Cidlinou, Czech Republic.
authors.forename: Róbert
authors.initials: R
authors.lastname: Hromádka
authors.affiliation: 4th Department of Medicine, 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.
authors.forename: Barbora
authors.initials: B
authors.lastname: Staňková
authors.affiliation: IVth Dept Internal Med, 1st Fac. Med., Charles Univ., Prague, Czech Republic.
authors.forename: Eva
authors.initials: E
authors.lastname: Tvrzická
authors.affiliation: 4th Department of Medicine, 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.
authors.forename: Aleš
authors.initials: A
authors.lastname: Žák
mesh_terms: D000818:Animals; D002318:Cardiovascular Diseases / Q000097:blood / Q000188:drug therapy; D006801:Humans; D006949:Hyperlipidemias / Q000188:drug therapy*; D000960:Hypolipidemic Agents / Q000009:adverse effects / Q000627:therapeutic use; D009525:Niacin / Q000009:adverse effects* / Q000627:therapeutic use*; D012307:Risk Factors
chemical_list: D000960:Hypolipidemic Agents; D009525:Niacin