Niacin as antidyslipidemic drug

Abstract

Niacin is an important vitamin (B3) that can be used in gram doses to positively modify pathogenetically relevant lipid disorders: elevated LDL cholesterol, elevated non-HDL cholesterol, elevated triglycerides, elevated lipoprotein(a), and reduced HDL cholesterol. This review reports the latest published findings with respect to niacin's mechanisms of action on these lipids and its anti-inflammatory and anti-atherosclerotic effects. In the pre-statin era, niacin was shown to have beneficial effects on cardiovascular end-points; but in recent years, two major studies performed in patients whose LDL cholesterol levels had been optimized by a statin therapy did not demonstrate an additional significant effect on these end-points in the groups where niacin was administered. Both studies have several drawbacks that suggest that they are not representative for other patients. Thus, niacin still plays a role either as an additive to a statin or as a substitute for a statin in statin-intolerant patients. Moreover, patients with elevated triglyceride and low HDL cholesterol levels and patients with elevated lipoprotein(a) concentrations will possibly benefit from niacin, although currently the study evidence for these indications is rather poor. Niacin may be useful for compliant patients, however possible side effects (flushing, liver damage) and contraindications should be taken into consideration.

Current Role of Lipoprotein Apheresis in the Treatment of High-Risk Patients

“…Previously, niacin was demonstrated to lower Lp(a) by about 20%. However, outcome data did not prove any benefit from this reduction [ 7 ].…”

Long-term consumption of energy drinks induces biochemical and ultrastructural alterations in the heart muscle

“…Some EDs (5-hour ENERGY shots, Monster, Rockstar Energy, and Red Bull) contain niacin (vitamin B3) in doses above the daily recommended intake. Niacin has positive effects in restoring a healthy lipid profile and delaying the progression of atherosclerosis ( 9 ). It has been used for more than half a century in the treatment of lipid disorders, such as abnormally elevated concentrations of LDL, non-HDL cholesterol, triglycerides, and lipoproteins and low concentrations of HDL ( 9 , 10 ).…”

Effects of green tea on lipid metabolism in overweight or obese people: A meta‐analysis of randomized controlled trials

“…Additionally, the increasing ratio of total cholesterol to HDL is the optimal marker of cardiovascular disease . To decrease the risk of cardiovascular disease, medications including niacin and omega‐3 fatty acid and statins are frequently used to alleviate dyslipidemia; however, their adverse effects, which include headaches, flushing, liver injury and abnormally high LDL, attract negative public attention . A more effective and safe substance should be studied and applied to prevent and treat dyslipidemia.…”