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Measure for measure—sugar or fats? Reconciling cardiovascular and diabetes risk with niacin therapy

Nature Clinical Practice Endocrinology & Metabolism volume 3, pages 72–73 (2007)Cite this article

The metabolic syndrome (MS) is a collection of risk factors accompanied by an increased risk for cardiovascular events and type 2 diabetes mellitus (T2DM).1 Statins are considered the initial preventive therapy to reduce cardiovascular events among patients with MS and T2DM; however, even those patients who achieve optimal LDL cholesterol (LDL-C) targets with statin treatment remain at excess cardiovascular risk.1 Niacin therapy in combination with a statin has consistently been shown to arrest the progression of atherosclerosis and reduce cardiovascular events in populations that include patients with MS and T2DM; nevertheless, niacin has been considered a reserve therapeutic agent because it worsens hyperglycemia. This Viewpoint argues that the lipoprotein-altering effects of niacin outweigh the potential hazards of niacin-mediated hyperglycemia in patients with metabolic symptoms.

Lipoproteins are important modifiable risk factors in MS and T2DM. Although high LDL-C levels are not a component of insulin resistance, small LDL particle size is associated with the atherogenic dyslipoproteinemia of insulin resistance. Small LDL particles carry less cholesterol than large LDL particles, and the overall LDL-C levels do not account for the high numbers of LDL particles observed in MS.2

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  1. Division of Cardiovascular Medicine, University of Michigan, Domino's Farms, 24 Frank Lloyd Wright Drive, Lobby A, Ann Arbor, MI 48106, USA rrosenson@umich.edu

Authors and Affiliations

  1. RS Rosenson is a Professor of Medicine and the Director of Lipoprotein Disorders and Clinical Atherosclerosis, University of Michigan Medical Center, Ann Arbor, MI, USA.,

    Robert S Rosenson

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  1. Robert S Rosenson
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Competing interests

Dr Rosenson is on the speaker's bureau for Kos Pharmaceuticals and LipoScience Inc, holds research grants from Kos Pharmaceuticals, is on the advisory board of LipoScience Inc, and holds a nonsignificant equity interest in LipoScience Inc.

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Rosenson, R. Measure for measure—sugar or fats? Reconciling cardiovascular and diabetes risk with niacin therapy. Nat Rev Endocrinol 3, 72–73 (2007). https://doi.org/10.1038/ncpendmet0392

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