Effects of extended-release niacin on lipoprotein profile and inflammatory markers

Addition of extended-release (ER) niacin (nicotinic acid) to existing statin therapy in patients with coronary heart disease (CHD) led to improvement in the distribution of lipoprotein particle sizes and inflammatory markers, suggesting potential for atheroprotection, according to a study reported in the American Journal of Cardiology.1

Fifty-four patients with stable CHD were randomised to treatment with ER niacin (500 mg daily for 2 weeks then increasing to 1000 mg daily) or placebo for 3 months. All patients were already receiving a stable dose of statin (>80% on atorvastatin). Baseline lipid measurements were similar in each group.

At 3 months, patients treated with ER niacin had a 7.5% increase in levels of total high-density lipoprotein (HDL) cholesterol and a 15% decrease in triglycerides relative to baseline, whereas levels of low-density lipoprotein (LDL) and total cholesterol remained unchanged. ER niacin also produced a shift in lipoprotein particle size, with a 32% increase in large particle HDL (p<0.001), an 8% decrease in small particle HDL (p=0.0032), an 82% increase in large particle LDL (p=0.09) and a 12% decrease in small particle LDL (p=0.008). Lipoprotein-associated phospholipase A2 and C-reactive protein levels were decreased by 20% and 15% (p<0.05) in the ER niacin group. There were no significant changes from baseline in any of these parameters in the placebo group.

The authors concluded that further beneficial alterations in lipoproteins and inflammatory markers could be achieved by the addition of niacin to existing statin therapy in patients with stable CHD.

Reference

1. Kuvin JT, Dave DM, Sliney KA et al. Effects of extended-release niacin on lipoprotein particle size, distribution, and inflammatory markers in patients with coronary artery disease. Am J Cardiol 2006;98:743-5.

Commentary

This paper adds to a growing body of evidence that the combination of a statin plus niacin is especially effective in both correcting lipid disorders and reducing inflammation. In this study, substantial benefits associated with adding extended- release niacin to therapy with a statin were apparent with regard to reducing triglyceride and raising HDL cholesterol. The addition of niacin also increased the levels of the protective large HDL particles and reduced levels of several inflammatory markers in plasma.