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..

Niacin/Nicotinic acid

Mechanism of benefit

• Reduces the level of low density lipoprotein (LDL) (17-26%)
• 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	Objective	Design	Population	Time period	Intervention	Results	Conclusions
The Coronary Drug Project	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)

References

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