Niacin in cardiovascular disease: novel observations
Niacin in cardiovascular disease: recent preclinical and clinical developments.Digby JE, Ruparelia N, Choudhury RP.
Arterioscler Thromb Vasc Biol. 2012;32:582-8.
This publication gives a re-appraisal of the use of niacin in clinical practice, based on its mechanism of action and nonlipoprotein mediated actions.
SummaryNiacin (nicotinic acid) has been used for more than 50 years to treat cardiovascular disease . Niacin increases HDL-C  and reduces LDL-C , VLDL-C and lipoprotein(a) . Although it is an effective therapy in raising HDL-C, the side effect of cutaneous flushing has limited its use . As with treating dyslipdemias with statins a significant CV risk remains [5-7], HDL-C elevation is a rational target for lipid intervention. HDL-raising CETP inhibitors are currently evaluated in Phase III trials; niacin is still the most effective available drug. The beneficial effects may go beyond lipoprotein modulation, with direct effects on endothelial cells, immune cells, and adipocytes, which could potentially change the indications for the use of niacin. New agents may in the future be able to show pleiotropic anti-inflammatory effects without the side effects that limited the use of niacin.
Niacin has pleiotropic lipoprotein independent actions that might be beneficial, by anti-inflammatory effects on cell types involved in the progression of atherosclerosis. These actions might contribute to the clinical benefits of niacin treatment.
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