Niacin Alternatives for Dyslipidemia: Fool’s Gold or Gold Mine? Part I: Alternative Niacin Regimens

Abstract Niacin was the first drug demonstrating lowered cholesterol prevents coronary heart disease (CHD) events, with two clinical CHD outcome studies establishing a cardioprotective niacin regimen: 1 g thrice daily with meals. Though cardioprotective, skin toxicity limits niacin’s use, fostering several variations to improve tolerability. One of these, an extended-release (ER) alternative, proved immensely successful commercially, dominating clinical practice despite departing from the established regimen in several critical ways. Hence, improved tolerability may have come at the cost of diminished efficacy, posing a conundrum: Does it still help the population at risk for CHD to broaden a drug’s acceptance by “watering it down”? This question is crucial at this stage now that the ER alternative failed to recapitulate the benefits of the established cardioprotective niacin regimen in two trials of the alternative approach: AIM-HIGH and HPS2-THRIVE. Part I of this review discusses how vastly the ER alternative departs from the established cardioprotective regimen, why that is important physiologically, and how it may explain the findings of AIM-HIGH and HPS2-THRIVE. Given important gaps left by statin therapy, the established cardioprotective niacin regimen remains an important evidence-based therapy for the statin intolerant or statin averse.
Source: Current Atherosclerosis Reports - Category: Cardiology Source Type: research

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CONCLUSION: Atherosclerosis may be associated with an increased risk of post-stroke dementia. Post-stroke statin use was associated with decreased risk of cognitive impairment. To confirm whether or not statins confer advantages in the post-stroke population in terms of preventing cognitive decline over and above their known effectiveness in reducing risk of further vascular events, further stroke trials including cognitive assessment and observational analyses adjusted for key confounders, focusing on key subgroups or statin use patterns are required. PMID: 31505259 [PubMed - as supplied by publisher]
Source: Ageing Research Reviews - Category: Genetics & Stem Cells Authors: Tags: Ageing Res Rev Source Type: research
Hyperlipidemia is a condition of abnormally high lipids levels in the blood which has been ranked as one of the greatest risk factors contributing to prevalence and severity of coronary heart disease. The available antihyperlipidemic drugs have been associated with some side effects however, herbal management of hyperlipidemia are relatively safe, cheap and readily available.P. conophora is an edible plant consumed in Nigeria as snack and speculated to have beneficial effect on blood lipid profile. The present study evaluates anti-hyperlipidemic effect of aqueous extract of cookedP.  conophoranut usingin vivo andin vi...
Source: International Journal of Phytomedicine - Category: Science Authors: Source Type: research
Authors: Liberopoulos E, Rallidis L, Spanoudi F, Xixi E, Gitt A, Horack M, Ashton V, Brudi P, Lautsch D, Ambegaonkar B, Elisaf M Abstract Introduction: Current European guidelines recommend treatment with lipid-lowering therapy (LLT) to a low-density lipoprotein cholesterol (LDL-C) target of
Source: Archives of Medical Science - Category: General Medicine Tags: Arch Med Sci Source Type: research
Stopping statins raises heart attack risk by almost half for over 75s, researchers find Related items fromOnMedica Glucosamine supplements may reduce stroke risk Vitamin D supplements do not confer cardiovascular protection Gestational diabetes raises long-term CVD risk Coronary heart disease remains UK ’s biggest killer Heart disease and stroke deaths plummet in Scotland
Source: OnMedica Latest News - Category: UK Health Source Type: news
The relationship between cholesterol levels and stroke has been much less clear than between cholesterol levels and coronary heart disease. This is likely mostly due to the inadequate power of older studies and the low intensity of cholesterol-lowering interventions at that time available. Because a reduction in stroke has been, conversely, clearly observed in trials with statins, for long “pleiotropic” effects of such drugs, unrelated to cholesterol lowering, have been invoked. In a previous analysis of all randomized trials of cholesterol-lowering treatments reporting on stroke we had, however, reached the co...
Source: The American Journal of Medicine - Category: General Medicine Authors: Tags: Clinical Research Study Source Type: research
Publication date: Available online 1 July 2019Source: The Lancet Diabetes &EndocrinologyAuthor(s): Kausik K Ray, Helen M Colhoun, Michael Szarek, Marie Baccara-Dinet, Deepak L Bhatt, Vera A Bittner, Andrzej J Budaj, Rafael Diaz, Shaun G Goodman, Corinne Hanotin, Robert A Harrington, J Wouter Jukema, Virginie Loizeau, Renato D Lopes, Angèle Moryusef, Jan Murin, Robert Pordy, Arsen D Ristic, Matthew T Roe, José TuñónSummaryBackgroundAfter acute coronary syndrome, diabetes conveys an excess risk of ischaemic cardiovascular events. A reduction in mean LDL cholesterol to 1·4–1·...
Source: The Lancet Diabetes and Endocrinology - Category: Endocrinology Source Type: research
Authors: Alves-Ferreira J, Rocha-Neves J, Dias-Neto M, F Braga S Abstract Objetives: Carotid endarterectomy (CEA) is an established treatment for carotid stenosis (CS). However, this procedure is not risk-free and it is insufficient to control disseminated atherosclerosis. Our aim was to determine long-term cardiovascular (CV) morbidity and mortality after CEA and identify associated risk predictors. DESIGN: Consecutive cohorts of CEAs performed between 2010-2018 in two Portuguese hospitals were retrospectively analysed. The major end-points were acute myocardial infarction (AMI), stroke, all-cause death and ma...
Source: Scandinavian Cardiovascular Journal - Category: Cardiology Tags: Scand Cardiovasc J Source Type: research
CONCLUSION: The novel predictive nomogram achieved a good preoperative prediction of CSA-AKI within the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Though the model, the risk of an individual patient with "subclinical AKI" undergoing cardiac surgery could be determined earlier and such application was helpful for timely intervention in order to improve patient's prognosis. PMID: 31243735 [PubMed - as supplied by publisher]
Source: Journal of Nephrology - Category: Urology & Nephrology Authors: Tags: J Nephrol Source Type: research
Supplementation not associated with reduced risks of CVD events or all-cause mortality in meta-analysis Related items fromOnMedica Coronary heart disease remains UK ’s biggest killer NICE says far more people should take statins Type 2 diabetes in 10 times more young people than realised Sugar not saturated fat is the major issue for CVD Physical activity might offset harms of time spent sitting
Source: OnMedica Latest News - Category: UK Health Source Type: news
Conclusion: Treatment with statins prevents ischemic stroke, especially in patients with high cardiovascular risk and established atherosclerotic disease. It seems that both lipid lowering and pleiotropic effects contribute to these effects. PMID: 31218948 [PubMed - as supplied by publisher]
Source: Current Medicinal Chemistry - Category: Chemistry Authors: Tags: Curr Med Chem Source Type: research
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