Cardiovascular disease niacin effect

Millions of people in the world suffer from cardiovascular disease, and it is a leading cause of death in both men and women. Elevation in plasma low-density lipoprotein (LDL) cholesterol levels is a major risk factor for myocardial infarction (heart attack) in these patients. Drugs to reduce dyslipidemia have included niacin and the fibrate class, but each of these has clinical limitations, such as low efficacy or toxic side effects. The development of HMG-CoA reductase inhibitors, or statins, has had an enormous clinical impact on the treatment of heart disease and prevention of heart attack, and these are taken by tens of millions of patients worldwide [1]. One of the first such drugs, lovastatin, was discovered in the 1970s as a fungal natural product [2] and lowered lipid levels in animals and healthy volunteers. Problems with the development of another early statin, compactin, halted advancement of lovastatin to regular clinical use until the late 1980s. Since then. 

B vitamins. Among the 13 vitamins, B vitamins are eight water-soluble vitamins (vitamin Bp thiamine vitamin B2 riboflavin vitamin B3 niacin vitamin B5 pantothenic acid vitamin Bg pyridoxine, pyridoxal or pyridoxamine vitamin B7 biotin vitamin B9 folic acid or folate and vitamin B cyanoco-balamin). Folate and vitamins Bg and B12 have joint effects on homocysteine. Cardiovascular disease. Cardiovascular disease (CVD) is a group of disorders of the heart and blood vessels and includes coronary heart disease, cerebrovascular disease, peripheral arterial disease, rheumatic heart disease, congenital heart disease (malformations of heart structure existing at birth) and deep vein thrombosis and pulmonary embolism. 

Niacin deficiency leads to unwanted multisystemic problems that are often associated with dermatological changes. Pellagra is a condition in which niacin deficiency causes a symmetrical pigmented rash, thickened skin and superficial scaling which are found in sun-exposed body areas. The classic triad of niacin deficiency are the three D s—dermatitis, diarrhoea and dementia (Hegyi et al. 2004). Some of the effects on the central nervous system include depression, anxiety, restlessness and poor concentration. In addition, alcoholic individuals with poor nutrition can develop pellagroid encephalopathy (Cook et al. 1998). The role of niadn deficiency in cardiovascular disease and lipid metabolism remains to be fully explored. 

Niacin is a water-soluble vitamin that has been available as a lipid-lowering medication and in prevention of atherosclerosis for half a century (Ganji et al. 2003 Olsson 2010). Numerous studies have documented its beneficial effects on reducing cardiovascular disease (CVD) (Olsson 2010). Clinically, the most well-known effect of niacin deficiency is pellagra which, as noted above, is manifested by dermatitis, diarrhoea and dementia (Bodor and Offermanns 2008 Ganji, et al. 2003). In this chapter we look at the effects of niacin on human physiology and its consequent effects on disease states. 

The protective effect of niacin against cardiovascular disease is subject of ongoing clinical trials. 

Combination therapy with niacin and a statin has also been shown to produce clinical and angiographic benefits. Brown et al. (56) evaluated the effects of simvastatin in combination with niacin on patients with documented coronary disease in the HATS trial and demonstrated a significant reduction in nonfatal MI or death from cardiovascular causes compared to placebo, albeit with a relatively small number of patients. In the treatment arm, HDL cholesterol increased by 26% over the three years of treatment and was also associated with a slight regression (0.4%) in coronary mean percent stenosis in the proximal arteries by invasive arteriography the placebo arm experienced a 3.9% increase in stenoses. 

The individual vitamin demand varies widely and is also dependent on the personal constitution. Stressful situations and e.g. pregnancy require a higher vitamin intake. For men, the recommended daily dose of Vitamin A, Bj, B2, Bg, K and niacin is usually higher than for women. There are series of studies, which confirm the breadth of application and the tolerability of vitamins and other micronutrients. The pharmacological effects with high doses of antioxidant provitamins and vitamins (especially )S-carotene and Vitamins C and E) in the treatment of cardiovascular and other diseases have been encouraging, albeit further controlled clinical studies will be needed to substantiate these observations. 

Coverage includes B vitamins and folate in the context of a historical background, disease, cardiovascular effects and the importance of vitamins in biochemistry as illustrated by a single vitamin. Thereafter there are chapters on the chemistry and biochemistry of thiamine, riboflavin, niacin, pantothenic acid, pyridoxine, biotin, folate and cobalamin. Methodical aspects include characterization and assays of B vitamins and folate in foods of all kinds, dietary supplements, biological fluids and tissues. The techniques cover solid-phase extraction, spectrofluorimetry, mass spectrometry, HPLC, enzymatic assay, biosensor and chemiluminescence. In terms of fimction and effects or... 

Duggal, J.K., Singh, M., Attri, N., Singh, P.P., Ahmed, N., Pahwa, S., Molnar, J., Singh, S., Khosla, S., and Arora, R., 2010. Effect of niacin therapy on cardiovascular outcomes in patients with coronary artery disease. Journal of Cardiovascular Pharmacology and Therapeutics. 15 158-166. 

---