Atherogenic
dyslipidemia, defined by a cluster of
lipoprotein abnormalities, including low
high-density lipoprotein cholesterol (HDL-C) and elevated serum
triglycerides, represents an important potential target for reducing cardiovascular risk. This has paved the way for revisiting
niacin as a
therapy in preventing progression of
atherosclerosis.
Niacin remains the safest and most effective agent for raising HDL-C and is a logical choice to target atherogenic
dyslipidemia. While the clinical efficacy of
niacin has been known for many years, it is only with development of newer formulations, which have lower side-effect profiles and improved compliance, that the potential for this agent been fully realized. In this review, we will examine some of the reasons that
niacin can have important implications for reducing progression of
atherosclerosis. We will first examine the different formulations and their variability, not only in side-effect profiles, but also in clinical efficacy. We will then consider the theoretical evidence for the benefit of HDL-raising produced by
niacin on atherosclerotic progression. Finally, we will review clinical data suggesting the benefit of
niacin on cardiovascular outcomes.