Abstract
Nicotinic acid (niacin) is the first ever hypolipidemic agent to have been introduced in clinical practice. It was demonstrated to have beneficial effect in individuals with low HDL-cholesterol and high LDL-cholesterol levels, as well as in patients with hypertriglyceridaemia, the common daily dose being 2 g.
Besides the pharmacokinetics and pharmacodynamics of niacin, the present communication brings also the current view on the mechanism of action and efficacy of the preparation. New is also its combination with laropiprant, the latter limiting substantially the occurrence of the most significant undesirable effect of niacin, flushing, though it has no effects in terms of lipid level adjustment.
Niacin is currently recommended particularly as part of combination therapy with statins. It has also been mentioned in the most recent European recommendations that stress not only its comprehensive effects, but also its ability to influence lipoprotein(a).
This is the particular reason why niacin is used as part of attempts to influence the so-called residual cardiovascular risk, based mainly on low HDL-cholesterol level and high triglycerides. In the light of evidence-based medicine, the data on niacin cannot be compared with the robust data obtained for statins, on the other hand, however, niacin can rely on rather convincing evidence from a number of older as well as recent studies.
A truly convincing data based on a 10,000 patient sample, however, can be expected to be available only after the results of the HPS2-THRIVE trial will have been published