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Niacin: The Evidence, Clinical Use, and Future Directions

  • Nonstatin Drugs (W Borden, Section Editor)
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Abstract

The use of FDA-approved niacin (nicotinic acid or vitamin B3) formulations at therapeutic doses, alone or in combination with statins or other lipid therapies, is safe, improves multiple lipid parameters, and reduces atherosclerosis progression. Niacin is unique as the most potent available lipid therapy to increase high-density lipoprotein (HDL) cholesterol and it significantly reduces lipoprotein(a). Through its action on the GPR109A receptor, niacin may also exert beneficial pleiotropic effects independent of changes in lipid levels, such as improving endothelial function and attenuating vascular inflammation. Studies evaluating the impact of niacin in statin-naïve patients on cardiovascular outcomes, or alone and in combination with statins or other lipid therapies on atherosclerosis progression, have been universally favorable. However, the widespread use of niacin to treat residual lipid abnormalities such as low HDL cholesterol, when used in combination with statins among patients achieving very low (<75 mg/dL) low-density lipoprotein cholesterol levels, is currently not supported by clinical outcome trials.

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Disclosure

T.C. Villines has received honorarium from Boehringer-Ingelheim; A.S. Kim: none; R.S. Gore: none; A.J. Taylor has received honorarium from Abbott.

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Authors and Affiliations

  1. Cardiology Service, Department of Medicine, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD, 20889, USA

    Todd C. Villines, Andrew S. Kim & Rosco S. Gore

  2. Washington Hospital Center, 110 Irving Street Northwest, Washington, DC, 20010-3017, USA

    Allen J. Taylor

  3. Georgetown University School of Medicine, 110 Irving Street Northwest, Washington, DC, 20010-3017, USA

    Allen J. Taylor

  4. Uniformed Services University School of Medicine, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA

    Todd C. Villines

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Villines, T.C., Kim, A.S., Gore, R.S. et al. Niacin: The Evidence, Clinical Use, and Future Directions. Curr Atheroscler Rep 14, 49–59 (2012). https://doi.org/10.1007/s11883-011-0212-1

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