Hypertriglyceridemia niacin
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S. [2]
Overview
Treatment of hypertriglyceridemia is by restriction of carbohydrates and fat in the diet, as well as with niacin, fibrates and statins (three classes of drugs). Increased fish oil intake may substantially lower an individual's triglycerides.[1][2][3].
Niacin/Nicotinic acid
Mechanism of benefit
- Reduces the level of low density lipoprotein (LDL) (17-26%)[4]
- Increases the level of high density lipoprotein (HDL)
Dosage
1.5 - 2 gm once daily
Formulation
- Crystalline
- Extended release form
Advantages
- Statin alone or combination therapy of niacin with statin are usually the first options used in patients with increased risk of premature coronary artery disease.
- Decreases the progression of atherosclerosis in hypertriglyceridemia patients.
Side-effects
- Flushing
- Pruritus
- Nausea
- Hepatitis (higher doses)
Contraindication
- Hypersensitivity
- Hepatic disease
Niacin treatment showed modest benefit in decreasing definite nonfatal recurrent myocardial infarction but did not decrease total mortality. With a mean follow-up of 15 years, nearly 9 years after termination of the trial, mortality from all causes in each of the drug groups, except for niacin, was similar to that in the placebo group. Mortality in the niacin group was 11% lower than in the placebo group (52.0 versus 58.2%; p = 0.0004). This late benefit of niacin, occurring after discontinuation of the drug, may be a result of a translation into a mortality benefit over subsequent years of the early favorable effect of niacin in decreasing nonfatal reinfarction or a result of the cholesterol-lowering effect of niacin, or both.
Supportive trial data
| Study name | Source & year | Study question | Study Design | Study Population | Time period | Intervention | Results | Conclusions |
| The Coronary Drug Project [5] | J Am Coll Cardiol, 1986 | Assess the long-term efficacy and safety of five lipid-influencing drugs | RCT | 8,341 men aged 30 to 64 years with h/o ECG confirmed myocardial infarction | 1966 and 1975 | five lipid-influencing drugs | 15% reduction in the risk of MI among men with hypercholesterolemia and decreased total mortality by 10% at 15 years of follow up | Favorable effect of niacin in decreasing non-fatal reinfarction (late benefit) |
| Arterial Biology for the Investigation of the Treatment Effects of Reducing Cholesterol (ARBITER) 2 [6] | Circulation, 2004 | Assess the long-term efficacy and safety of five lipid-influencing drugs | Double-blind randomized placebo-controlled study | 167 patients (mean age 67 years), h/o coronary heart disease, low HDL(<45 mg/dL) | 1 year | Once-daily extended-release niacin (1000 mg) added to background statin therapy | Increase in HDL-C by 21% and unchanged mean CIMT in the niacin group after 12 months | Decreases progression of carotid artery disease in patients with atherosclerosis and statin therapy |
References
- ↑ "Lipids Online Slides: hypertriglyceridemia, ICAM-1, fish oil, E-selectin".
- ↑ Terres W, Beil U, Reimann B, Tiede S, Bleifeld W (1991). "[Low-dose fish oil in primary hypertriglyceridemia. A randomized placebo-controlled study]". Zeitschrift für Kardiologie (in German). 80 (1): 20–4. PMID 2035283.
- ↑ "Fish oils in hypertriglyceridemia - Fish Oils Revisited Nutrition Research Newsletter - Find Articles".
- ↑ Brunzell JD (2007). "Clinical practice. Hypertriglyceridemia". N Engl J Med. 357 (10): 1009–17. doi:10.1056/NEJMcp070061. PMID 17804845.
- ↑ Canner PL, Berge KG, Wenger NK, Stamler J, Friedman L, Prineas RJ; et al. (1986). "Fifteen year mortality in Coronary Drug Project patients: long-term benefit with niacin". J Am Coll Cardiol. 8 (6): 1245–55. PMID 3782631.
- ↑ Taylor AJ, Sullenberger LE, Lee HJ, Lee JK, Grace KA (2004). "Arterial Biology for the Investigation of the Treatment Effects of Reducing Cholesterol (ARBITER) 2: a double-blind, placebo-controlled study of extended-release niacin on atherosclerosis progression in secondary prevention patients treated with statins". Circulation. 110 (23): 3512–7. doi:10.1161/01.CIR.0000148955.19792.8D. PMID 15537681.