New expert text on cholesterol (lipids) 

Niacin Therapy: Impact on Dyslipidemia and Cardiovascular Events in Diabetic Patients

• Henry A. Tran M.D., M.Sc.,
• Arthur Z. Schwartzbard M.D., F.A.C.C.,
• James A. Underberg M.D., M.S., F.A.C.P.M., F.A.C.P., F.A.S.H., F.N.L.A.

 

Abstract

Patients with diabetes mellitus often have deleterious changes in the lipoprotein profile leading to accelerated atherogenesis and increased risk of cardiovascular disease. Niacin (nicotinic acid) was the first pharmacologic agent demonstrated to lower serum cholesterol. It remains the most clinically efficacious drug available to increase serum HDL-C and lower triglycerides.

 Several clinical trials that included patients with diabetes have demonstrated modest clinical benefits with niacin therapy.

 The characteristic flushing after niacin administration limits its tolerability; however, niacin-induced hyperglycemia and hepatotoxicity must also be considered. Although the reduction of LDL-C with statins is the cornerstones of current antilipidemic therapy, niacin therapy may still be clinically beneficial as adjuvant therapy