Niacin: The Evidence, Clinical Use, and Future Directions

@article{Villines2011NiacinTE,
  title={Niacin: The Evidence, Clinical Use, and Future Directions},
  author={Todd C. Villines and Andrew S Kim and Rosco S Gore and Allen J. Taylor},
  journal={Current Atherosclerosis Reports},
  year={2011},
  volume={14},
  pages={49-59}
}
The use of FDA-approved niacin (nicotinic acid or vitamin B3) formulations at therapeutic doses, alone or in combination with statins or other lipid therapies, is safe, improves multiple lipid parameters, and reduces atherosclerosis progression. Niacin is unique as the most potent available lipid therapy to increase high-density lipoprotein (HDL) cholesterol and it significantly reduces lipoprotein(a). Through its action on the GPR109A receptor, niacin may also exert beneficial pleiotropic… Expand
Nicotinic acid as a lipid-modifying drug--a review.
TLDR
Because of its HDL cholesterol raising properties, nicotinic acid appears to be an ideal companion to statins since low HDL cholesterol concentration has been shown to negatively influence statin-treated patients even when ideal LDL cholesterol concentrations have been reached. Expand
Plaque imaging to refine indications for emerging lipid-lowering drugs
Statins have been effective in reducing adverse cardiovascular events. Their benefits have been proportional to the level of plasma LDL-cholesterol reduction and seem to extend to patients withExpand
Remarkable quantitative and qualitative differences in HDL after niacin or fenofibrate therapy in type 2 diabetic patients.
TLDR
ERN/LRP and FFB had strikingly different effects on HDL quantity and quality, as well as on HDL cholesterol concentrations, so when prescribing HDL cholesterol increasing drugs, this differential action should be considered. Expand
Pharmacological interventions in human HDL metabolism
TLDR
In the poststatin era, personalized medicine, which is inevitably on the horizon, is likely to be helpful for patients who do not reach the goals for LDL cholesterol and HDL-c according to the guidelines, and functions of HDL will hopefully be identified as future pharmacological targets. Expand
Lipid Management in Chronic Kidney Disease: Systematic Review of PCSK9 Targeting
TLDR
A detailed analysis of CKD subgroups in general population trials of anti-PCSK9 strategies addressing events is needed, given the limited efficacy of statins in CKD both in terms of lipid lowering and events, the high rate of statin non-compliance in these patients, and the high lipoprotein(a) levels. Expand
Latest developments in the treatment of lipoprotein (a)
TLDR
Multiple agents, including the next generation RNA-based antisense therapeutics have Lp(a) lowering properties, however, it remains to be established whether lowering Lp (a) reduces cardiovascular disease events with specific Lp’s lowering therapies. Expand
Effects of formulation design on niacin therapeutics: mechanism of action, metabolism, and drug delivery.
TLDR
An overview of niacin applications, its metabolic pathways, and current drug delivery formulations is presented and focus is placed on oral immediate, sustained, and extended release niacIn delivery as well as combined statin and/or prostaglandin antagonist niac in formulation. Expand
Nicotinic Acid and Nicotinamide: A Review of Their Use for Hyperphosphatemia in Dialysis Patients
TLDR
Both nicotinic acid and nicotinamide were effective in significantly reducing serum phosphorus concentrations in patients with ESRD on either hemodialysis or peritoneal dialysis. Expand
Significantly Elevated Levels of Plasma Nicotinamide, Pyridoxal, and Pyridoxamine Phosphate Levels in Obese Emirati Population: A Cross-Sectional Study
TLDR
The aim of the present study was to quantify various B6 vitamers, as well as B3, in the plasma of obese and healthy Emirati populations and to examine their correlation with obesity. Expand
Nicotinuric Acid
TLDR
This is the first study, to the authors' knowledge, to propose that nicotinuric acid represents an important pathogenic mechanism in process from metabolic syndrome to diabetes and atherosclerotic cardiovascular disease. Expand
...
1
2
3
4
...

References

SHOWING 1-10 OF 88 REFERENCES
Efficacy and Safety of Controlled-Release Niacin in Dyslipoproteinemic Veterans
TLDR
The safety and efficacy of controlled-release niacin is described in a sample of predominantly male veterans treated for lipid disorders and, in keeping with these guidelines, niacIn has been extensively promoted and used as a first-line agent. Expand
Simvastatin and niacin, antioxidant vitamins, or the combination for the prevention of coronary disease.
TLDR
Simvastatin plus niacin provides marked clinical and angiographically measurable benefits in patients with coronary disease and low HDL levels, and the use of antioxidant vitamins in this setting must be questioned. Expand
Effects of niacin on glucose control in patients with dyslipidemia.
TLDR
On a population basis, significant reductions in incidences of cardiovascular events and the degree of atherosclerotic progression associated with long-term niacin (or niac in-statin) therapy in patients with diabetic dyslipidemia outweigh the typically mild effects of this therapy on glycemic regulation. Expand
Niacin and fibrates in atherogenic dyslipidemia: pharmacotherapy to reduce cardiovascular risk.
TLDR
This comprehensive, critical review of available data in dyslipidemic subjects indicates that niacin is more efficacious in raising HDL-C than fibrates, whereasniacin and fibrate reduce TG-rich lipoproteins and LDL comparably. Expand
Effects of extended-release niacin on lipid profile and adipocyte biology in patients with impaired glucose tolerance.
TLDR
Treatment with ER niacin significantly improves atherogenic lipid profile in patients with IGT, characterized by decreased mean adipocyte size, increased insulin sensitivity and altered mRNA expression profile, which could at least in part be due to pleiotropic niacIn effects in adipose tissue. Expand
Meta-analysis of the effect of nicotinic acid alone or in combination on cardiovascular events and atherosclerosis.
TLDR
Although the studies were conducted before statin therapy become standard care, and mostly in patients in secondary prevention, this meta-analysis found positive effects of niacin alone or in combination on all cardiovascular events and on atherosclerosis evolution. Expand
Effect of niacin and atorvastatin on lipoprotein subclasses in patients with atherogenic dyslipidemia.
TLDR
In patients with atherogenic dyslipidemia, both drugs had important effects on lipoprotein subfractions, which contributed to a reduction in coronary heart disease risk, and both drugs equally reduced VLDL subclass levels. Expand
Effect of Niacin Therapy on Cardiovascular Outcomes in Patients With Coronary Artery Disease
TLDR
In a meta-analysis of seven trials of secondary prevention, niacin was associated with a significant reduction in cardiovascular events and possible small but non-significant decreases in coronary and cardiovascular mortality. Expand
A comparison of the efficacy and toxic effects of sustained- vs immediate-release niacin in hypercholesterolemic patients.
TLDR
The IR niacin is preferred for the management of hypercholesterolemia but can also cause significant adverse effects and should be given only to patients who can be carefully monitored by experienced health professionals. Expand
Efficacy and safety of high-density lipoprotein cholesterol-increasing compounds: a meta-analysis of randomized controlled trials.
TLDR
Fibrates reduce major coronary events and increase HDL-C levels without significant toxicity, and niacin has a more potent effect on HDL- C levels, whereas data on cardiovascular event rate reduction are limited. Expand
...
1
2
3
4
5
...