Nicotinic Acid in the Treatment of Hypercholesterolemia

Abstract

Evidence implicating hyperlipidemia in the pathogenesis of atherosclerosis continues to accumulate. As a result, methods for reducing lipid levels in man, both dietary and pharmacological, become increasingly important. Any practical lipid control program must be economical and must not produce undesirable side eff ects.Altschul et al. first reported a decrease in plasma cholesterol following large oral doses of nicotinic acid.'-Many subsequent studies have confirmed these results .2, 3 Large scale prospective clinical trials are underway at present. Studies published to date, however, contain few references to experiences totaling more than five years of continuous nicotinic acid therapy and evidence of the safety of long term use is still lacking. Nicotinic acid has been used as a treatment for hypercholesterolemia in this institution since 1957. We have reviewed our clinical experience with this drug in terms of its efficacy in lowering plasma cholesterol and its toxicity and practicality as a longterm agent. This report concerns 160 patients, some of whom have been followed for more than a decade. Our experience includes 868 patient years of treatment. MATERIALS AND METHODSPatients entered the study from 1957 through 1968. Patients were seen initially in the Vascular Clinic for evaluation of various clinical manifestations of atherosclerosis. Patients whose plasma cholesterol was greater than 260 mgs. per cent were instructed in a diet containing less than 300 mgs. of cholesterol daily and a polyunsaturated to saturated fat ratio of approximately 1.5 to 1. The caloric level was adjusted to bring each patient toward ideal body weight. Patients whose blood cholesterol remained above 260 mgs.% after 8 weeks of diet therapy were selected for treatment. There were four patients in this series whose initial cholesterol was less than 260 mgs.% in whom treatment was started because of clinical evidence of extensive symptomatic atherosclerosis.All patients were screened for secondary causes for hypercholesterolemia such as hypothyroidism, uncontrolled diabetes mellitus, nephrotic syndrome or obstructive biliary tract disease. Unless intercurrent illness demanded hospitalization, all followup examinations were carried out in the outpatient department.

A Comparative Review of the Adverse Effects of Treatments for Hyperlipidaemia

“…When the increases were restricted to this figure, liver function remained consistently normal. Occasional cases of hepatocellular toxicity or hepatitis have occurred, particularly with sustained release formulations (Charman et al 1972;Kohn & Montes 1969;Patterson et al 1983). Irreversible chronic active hepatitis has reportedly been precipi~ted by large doses of nicotinic acid (Christensen et al 1961).…”

Acanthosis nigricans Caused by Nicotinic Acid: Case Report and Review of the Literature

“…The use of nicotinic acid has however been limited by a variety of troublesome and sometimes serious side effects, which may cause up to 50% of patients to withdraw from the treatment [4J. Diar by aspirin [5,8,26,27], A number of more rare cutaneous side effects arc listed in table 1.…”