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Niacin in the metabolic syndrome: more risk than benefit?

Nature Clinical Practice Endocrinology & Metabolism volume 2, pages 300–301 (2006)Cite this article

Niacin (nicotinic acid) is a water-soluble vitamin that has been used for over 4 decades to treat patients with hyperlipidemia.1 Niacin therapy significantly reduces plasma triglyceride and LDL-cholesterol levels and increases HDL-cholesterol. Additionally, niacin reduces levels of lipoprotein (a), fibrinogen, and plasminogen activator inhibitor 1. In the Coronary Drug Project (CDP),2 niacin reduced nonfatal coronary events and improved survival in men with coronary artery disease; moreover, niacin in combination with either bile-acid-binding resins or statins slowed progression of coronary artery disease.3

Although the lipid-altering effects of niacin were recognized over 50 years ago, we have yet to define the mechanism of action completely. In adipose tissue, niacin inhibits hormone-sensitive lipase, leading to decreased circulating fatty acids,1 an effect probably mediated by a member of the G-protein-coupled receptor family.4 Decreased flux of fatty acids could reduce VLDL production. Additionally, niacin decreases apolipoprotein A-I removal from plasma, possibly by decreasing hepatic apolipoprotein A-I degradation. Whether this effect also occurs via a G-protein-coupled receptor is not known.

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  1. the Irving Professor of Medicine and the Director of the Irving Center for Clinical Research, Columbia University College of Physicians and Surgeons, New York, NY, USA

    Henry N Ginsberg

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  1. Henry N Ginsberg
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Correspondence to Henry N Ginsberg.

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Competing interests

I have, in the past 2 years, consulted for the following pharmaceutical companies: Takeda, Kos, Merck, Merck-Schering Plough, Astra Zeneca, Bristol Myers Squibb, Novartis, Novo Nordisk, Johnson and Johnson, Bayer, Reliant, Roche, Reddy. I have given lectures sponsored by Merck, Takeda, Abbott. I own stock in Reddy Laboratories Ltd.

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Ginsberg, H. Niacin in the metabolic syndrome: more risk than benefit?. Nat Rev Endocrinol 2, 300–301 (2006). https://doi.org/10.1038/ncpendmet0199

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