Niacin in cardiovascular prevention: mechanisms, efficacy, and safety

  title={Niacin in cardiovascular prevention: mechanisms, efficacy, and safety},
  author={John R. Guyton},
  journal={Current Opinion in Lipidology},
  • J. Guyton
  • Published 1 August 2007
  • Biology, Medicine
  • Current Opinion in Lipidology
Purpose of review This review describes niacin's mechanism of action, efficacy in cardiovascular prevention, and safety. Recent findings A G-protein-coupled receptor [GPR109A/HM74A, mouse PUMA-G (protein upregulated in macrophages by interferon-γ)] was found to mediate the antilipolytic effect of niacin via inhibition of adenylyl cyclase in adipocytes. The same receptor in skin Langerhans cells mediates the common flushing side effect. The endogenous ligand for the receptor may be… 
Niacin: another look at an underutilized lipid-lowering medication
The utility of niacin is reviewed including its mechanism of action, clinical trial data regarding cardiovascular outcomes, adverse effect profile and strategies to address these effects and improve compliance are reviewed.
Abstract and Introduction
It is unlikely that any chronic lowering of BP by niacin is due to dilation of dermal vessels through activation of the DP1 receptor by PGD 2 , and further research is warranted to evaluate the extent and mechanisms of niacIn's effects on BP.
Effect of Extended-Release Niacin or Ezetimibe on Carotid Intimal Thickness: The ARBITER-HALTS Study
  • J. Farmer
  • Medicine, Biology
    Current atherosclerosis reports
  • 2010
The recent release of ezetimibe was welcomed as another pharmacologic approach to modify the lipid profile either in monotherapy or in combination with statins, but doubts about the clinical utility were raised when it failed to reduce carotid intimal thickness when added to full-dose simvastatin therapy.
Safety and efficacy of laropiprant and extended-release niacin combination in the management of mixed dyslipidemias and primary hypercholesterolemia
The uptake in clinical practice of the niacin–laropiprant combination will depend on the relative improvements experienced by the patient in the side-effect profile compared to other treatment options, as well as on the the keenly-awaited outcome studies currently underway.
Novel actions of niacin in immune system improves peripheral mononuclear cells cell viability, decrease in genotoxic stress, drug for hyperphosphatemia, improvement in symptoms of Parkinsonism and psoriasis, and the combination of ERN and Laropiprant in reducing overall risk of cardiovascular diseases is discussed in detail.
Does nicotinic acid (niacin) lower blood pressure?
It is unlikely that any chronic lowering of BP by niacin is due to dilation of dermal vessels through activation of the DP1 receptor by PGD2, but post hoc analyses of some of the more recent nacin clinical trials also support a more chronic, dose‐dependent, BP‐lowering effect of niacIn.
Expression of the Niacin Receptor GPR109A in Retina: More than Meets the Eye?
Preclinical and clinical studies documenting the expression of GPR109A are described, the pleiotropic effects elicited in response to its activation and the underlying mechanisms to explain these actions are described.


Niacin therapy in atherosclerosis
New data indicate that niacin alters lipoprotein metabolism in novel ways, and mediates other beneficial nonlipid changes that may be atheroprotective, forming the rationale for the use of niac in combination with agents possessing complementary mechanisms of action for cardiovascular risk reduction beyond that observed with monotherapy.
Niacin and cholesterol: role in cardiovascular disease (review).
A comparison of the efficacy and toxic effects of sustained- vs immediate-release niacin in hypercholesterolemic patients.
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.
Extended-release niacin for modifying the lipoprotein profile
  • J. Guyton
  • Medicine
    Expert opinion on pharmacotherapy
  • 2004
Niacin ER is as effective in modifying lipoprotein levels as an equal daily dose of niacin IR and it causes less flushing, and is not associated with the increased hepatotoxicity reported with SR formulations.
Niacin-induced myopathy.
Efficacy and long-term adverse effect pattern of lovastatin.
  • J. Tobert
  • Medicine
    The American journal of cardiology
  • 1988
Nicotinic Acid in the Treatment of Hypercholesterolemia
Clinical experience with nicotinic acid has been reviewed in terms of its efficacy in lowering plasma cholesterol and its toxicity and practicality as a longterm agent and evidence of the safety of long term use is still lacking.
Efficacy, safety, and tolerability of once-daily niacin for the treatment of dyslipidemia associated with type 2 diabetes: results of the assessment of diabetes control and evaluation of the efficacy of niaspan trial.
Low doses of ER niacin (1000 or 1500 mg/d) are a treatment option for dyslipidemia in patients with type 2 diabetes and no hepatotoxic effects or myopathy were observed.
Simvastatin and niacin, antioxidant vitamins, or the combination for the prevention of coronary disease.
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.