[Niacin--an additive therapeutic approach for optimizing lipid profile]

Large interventional studies have shown that the reduction of total cholesterol and low-density lipoprotein cholesterol (LDL-C) is one of the cornerstones in the prevention of coronary artery disease. However, in up to 40% of patients the recommended target of LDL-C is not reached with a monotherapy. Furthermore, risk stratification only by LDL-C disregards a substantial number of patients with dyslipidemia with increased triglycerides and decreased high-density lipoprotein cholesterol (HDL-C).

In consequence, niacin has gained attention as a component of a combined therapeutic approach in patients with dyslipidemia. Niacin substantially increases HDL-C and decreases triglycerides, LDL-C and lipoprotein (a). By this mechanism of action niacin exhibited, in combination with statins or bile acid-binding resins, favorable effects on the incidence of cardiovascular events in selected patients. Side effects like flush and hepatotoxicity seem to be in part dependent on the niacin formulations used. However, niacin has been shown to be a well-tolerated and safe therapy in controlled studies.

On the basis of current data niacin should be considered a valuable therapy component in patients with dyslipidemia, in which a monotherapy fails to optimize an increased risk of coronary artery disease.