Benefit Of Niacin Research Articles

Analgesic Benefit of Niacin for Shrapnel Wound Pain in War Veteran

We report a case of an 86-year-old male with a history of dyslipidemia, which had been treated with a medication regimen that included niacin. Upon discontinuation of niacin by his physician, he noticed recurrence of aching pain on the dorsal surface of the foot where he had a scar from a World War II shrapnel injury. With reinitation of niacin, his pain again abated.

Niacin as potential treatment for dyslipidemia and hyperphosphatemia associated with chronic renal failure: the need for clinical trials

Niacin has profound and unique effects on lipid metabolism. In addition to increasing high-density lipoprotein cholesterol, it is also known to decrease total cholesterol, low-density lipoprotein cholesterol, and triglyceride. Interestingly, the plasma concentration of lipoprotein(a) [Lp(a)], which has been suggested to play a role as an independent risk factor for coronary heart disease, is also decreased by niacin. Therefore, it is not surprising that in the literature it was given unique description as broad-spectrum lipid drug. Its impact is referred to as desirable normalization of a range of cardiovascular risk factors. However, its clinical use is limited due to harmless but unpleasant unique side effect of cutaneous flushing. Interestingly, recent experimental and clinical studies suggest the potential benefit of niacin as a treatment of dyslipidemia and high plasma phosphate associated with chronic kidney disease (CKD). Both dyslipidemia and high serum phosphate levels are shown to be associated with higher cardiovascular mortality. Furthermore, niacin administration improves renal tissue lipid metabolism, renal function and structure, hypertension, proteinuria, and histological tubulointerstitial injury. Further studies are required before the use of niacin for the treatment of both dyslipidemia and hyperphosphatemia with CKD advocated.

Benefits of Niacin in Patients With Versus Without the Metabolic Syndrome and Healed Myocardial Infarction (from the Coronary Drug Project)

This post hoc analysis from the Coronary Drug Project (CDP) evaluated the effects of niacin monotherapy on clinical outcomes in patients with and without the metabolic syndrome (MS). The CDP was a randomized, placebo-controlled clinical trial of lipid-modifying agents in men with previous myocardial infarction (MI). Of the 5 drug regimens, only niacin significantly decreased definite recurrent nonfatal MI at 6 years and total mortality at a 15-year follow-up. Patients treated with niacin (n = 1,119) and placebo (n = 2,787) were grouped according to the presence or absence of the MS at baseline. The MS was defined on the basis of meeting > or =3 of 5 criteria from the current National Cholesterol Education Program guidelines in a small subgroup of patients with high-density lipoprotein cholesterol determinations at baseline and on the basis of > or =3 of 4 criteria in the total population, excluding the high-density lipoprotein cholesterol criterion. Niacin decreased the occurrence of 6-year MI and 15-year total mortality similarly among patients with or without the MS. For example, in the total population, 15-year total mortality rates were 60% and 64% (hazard ratio 0.86) in patients with the MS treated with niacin and placebo, respectively, and 50% and 57% (hazard ratio 0.86) in those without the MS (Z for interaction = 0.06, indicating homogeneity of the treatment effect across groups). In conclusion, these results support the use of niacin in postinfarction patients with and without the MS.

Dyslipidaemia among Indo-Asians strategies for identification and management

ndo-Asians have the highest rates of coronary artery disease (CAD) despite the fact that nearly half are lifelong vegetarians. The incidence, prevalence, and mortality from CAD among overseas Indo-Asians have been 50% to 300% higher than the Europeans, Americans, and other Asians with a higher risk at younger ages. Approximately 10% of the adults in urban India have CAD, a rate similar to overseas Indians. Traditional risk factors do not fully explain the excess burden of CAD in Indo-Asians. Therefore, conventional approaches to testing and treatment of risk factors are not sufficient in this population. Indo-Asians have a higher prevalence of glucose intolerance, metabolic syndrome, diabetes, elevated concentrations of lipoprotein(a) (LP[a]), and homocysteine, and low concentrations of high density lipoprotein (HDL). HDL particles are also smaller in Indo-Asians than Whites. A more aggressive approach to all risk factors, including HDL, LP(a), triglycerides and homocysteine is warranted. The current evidence of established safety and broad spectrum lipoprotein benefits of niacin and statins would make these invaluable agents in the armamentarium against dyslipidaemia, especially in Indo-Asians. This is particularly true for those with metabolic syndrome, diabetic dyslipidaemia and Lp(a) excess.

Benefits of niacin by glycemic status in patients with healed myocardial infarction (from the Coronary Drug Project)

The Coronary Drug Project, conducted during 1966 to 1974, was a randomized, double-blind, placebo-controlled trial of 5 lipid-modifying agents in 8,341 men with previous myocardial infarction. Among the 5 drug treatment regimens, only niacin significantly reduced the risk of (1) cardiovascular events during a mean follow-up of 6.2 years and (2) total mortality during 6.2 years with study treatment plus an additional 9 years of post-trial follow-up (Figure 1). Cardiovascular and total mortality outcomes in the niacin and placebo groups are presented by baseline glycemic status and by change in glycemic status from baseline to year 1.

The benefits of niacin in atherosclerosis.

Niacin favorably alters all major lipid subfractions at pharmacologic doses. Alone or in combination, it promotes regression of coronary artery disease, decreases coronary events, stroke, and total mortality. Major recent progress in niacin is in four areas. Firstly, recent data indicate that it increases high-density lipoprotein (HDL) and lowers triglycerides and low-density lipoprotein (LDL) by mechanisms different from statins, fibrates, and bile-sequestrants, giving rationale for combination therapy to achieve synergistic effects for complete lipid goal achievement. Secondly, new data on an extended-release preparation of niacin given once nightly indicates that it is as effective and has greater tolerability than immediate-release niacin. Thirdly, preliminary data with a single tablet formulation extended-release niacin and an HMG CoA reductase inhibitor (lovastatin) shows it to be safe and very effective, especially for raising HDL. Finally, emerging evidence indicates that niacin can be used effectively and safely in patients with type 2 diabetes mellitus, who often have low HDL levels.