The Role of Niacin in the Management of Dyslipidemia

Abstract

Niacin or nicotinic acid has been used for the management of dyslipidemia for over 50 years, and it is the first medication that has been shown to reduce both coronary disease events and mortality. It is unique among the various lipid therapies in that it can not only reduce all of atherogenic lipid fractions (total cholesterol, low-density lipoprotein, very low-density lipoprotein, non-HDL lipoproteins, and triglycerides), but is also the most effective agent for raising high-density lipoprotein (specifically Apolipoprotein A-1). It is also the only lipid therapy that can lower lipoprotein (a). Niacin also has non-lipid benefits that improve vascular health and reduce atherogenesis. Niacin therapy was initially hampered by a high incidence of side effects, especially flushing, but this has largely been overcome by extended-release formulations and dosing and administering properly. Despite the failure of two recent clinical trials to show benefit of combining niacin with statins, there are many trials that support using niacin as monotherapy or in combination with other lipid agents including statins. Niacin is also the cheapest lipid agent available, and with the epidemic of cardiovascular disease in the world, it offers great value in the population-wide management of this health problem.