Abstract • Niacin significantly alters blood lipid concentrations but its use has been limited because of clinically disturbing side effects. In an attempt to circumvent these drawbacks, 55 patients with cardiovascular disease were given low-dose long-acting niacin, 1 g/d. Treatment was continued for a mean of 6.7 months and lipid values were compared with a nontreated group of 17 patients followed for a mean of 6.3 months. Lipid values did not change in the nontreated group. In the niacin-treated group total cholesterol and triglyceride levels also did not significantly change. High-density lipoprotein (HDL) cholesterol level rose 31% from 1.01 ±0.31 mmol/L to 1.32±0.31 mmol/L and total cholesterol/HDL cholesterol ratio was reduced 27% from 6.4±1.9 to 4.7±1.3. Despite these results, 40% of the patients left the study mainly because of side effects. Apart from one patient who developed overt diabetes, of questionable relationship to niacin, no patient developed serious side effects such as jaundice or peptic ulcer as seen with much higher doses of the drug. Although often difficult to administer to patients, niacin, particularly in low dose, deserves consideration as an inexpensive agent especially useful for elevating HDL cholesterol level and altering the total cholesterol/HDL cholesterol ratio. (Arch Intern Med 1988;148:2493-2495) References 1. Canner PL, Berge KG, Wenger NK, et al: Fifteen-year mortality in Coronary Drug Project patients: Long-term benefit with niacin. J Am Coll Cardiol 1986;8:1245-1255.Crossref 2. Blankenhorn DH, Nessim SA, Johnson RL, et al: Beneficial effects of combined colestipol-niacin therapy on coronary atherosclerosis and coronary venous bypass grafts. JAMA 1987;257:3233-3240.Crossref 3. Alderman JD, Monrad ES, Pasternack RG, et al: Major favorable changes in cholesterol and HDL in coronary patients using a modified niacin regimen. Circulation 1985;72( (suppl 3) ):471.Crossref 4. Zampogna A, Luria MH, Manubens SJ, et al: Relationship between lipids and occlusive coronary artery disease. Arch Intern Med 1980;140:1067-1069.Crossref 5. Allain CC, Poon LS, Chan CSG, et al: Enzymatic determination of total serum cholesterol. Clin Chem 1974;20:470-475. 6. Bucolo G, David H: Quantitative determination of serum triglycerides by the use of enzymes. Clin Chem 1973;19:476-482. 7. Steele BW, Koehler DF, Azar MM, et al: Enzymatic determinations of cholesterol in high-density lipoprotein fractions prepared by precipitation technique. Clin Chem 1976;22:98-101. 8. Kleinbaum DG, Kuper LL: Applied Regression Analysis and Other Multivariate Methods . North Scituate, Mass, Duxbury Press, 1978, pp 210-216. 9. Weiner M, van Eys J: Nicotinic Acid; Nutrient Cofactor-Drug . New York, Marcel Dekker Inc, 1983. 10. Vessby G, Lithel H, Gustafsson I-B, et al: Pronounced lipoprotein lipid reduction obtained by combined lipid-lowering treatment in patients with atherosclerotic disease. Atherosclerosis 1979;33:457-477.Crossref 11. Lundholm L, Jacobsson L, Brattsand R, et al: Influence of nicotinic acid, niceritrol and B-pyridylcarbinol on experimental hyperlipidemia and atherosclerosis in minipigs. Atherosclerosis 1978;29:217-239.Crossref 12. Schoch HK: The U. S. Veterans Administration Cardiology Drug-Lipid Study: An interim report. Adv Exp Med Biol 1969;4:405-420. 13. Levy RI, Klimov AN: High-density lipoprotein cholesterol and mortality in USSR and US middle age men. Circulation 1987;76( (suppl 4) ):167. 14. Levy RI, Brensike JF, Epstein SE, et al: The influence of changes in lipid values induced by cholestyramine and diet on progression of coronary artery disease: Results of the NHLBI Type II coronary intervention study. Circulation 1984;69:325-336.Crossref 15. Arntzenius AC, Kromhout D, Barth JD, et al: Diet lipoproteins and the progression of coronary atherosclerosis: The Leiden Intervention Trial. N Engl J Med 1985;312:805-811.Crossref 16. The Coronary Drug Project Research Group: Clofibrate and niacin in coronary heart disease. JAMA 1975;231:360-381.Crossref 17. Rosenhamer G, Carlson LA: Effect of combined clofibrate-nicotinic acid treatment in ischemic heart disease. Atherosclerosis 1980;37:129-138.Crossref 18. The Expert Panel: Report of the National Cholesterol Education Program: Expert panel on detection, evaluation and treatment of high blood cholesterol in adults. Arch Intern Med 1988;148:36-69.Crossref 19. Hoeg JM, Gregg RE, Brewer HB: An approach to the management of hyperlipoproteinemia. JAMA 1986;255:512-521.Crossref
Archives of Internal Medicine – American Medical Association
Published: Nov 1, 1988
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