Myocardial infarction niacin

A fibrate derivative or niacin should be considered in select patients with a low high-density lipoprotein (HDL) cholesterol less than 40 mg/dL (1.04 mmol/L) and/or a high triglyceride level greater than 200 mg/dL (2.26 mmol/L). In a large randomized trial in men with established CAD and low levels of HDL cholesterol, the use of gemfibrozil (600 mg twice daily) significantly decreased the risk of non-fatal myocardial infarction or death from coronary causes.78... 

Canner PL, Furberg CD, Terrin ML, McGovern ME (2005) Benefits of niacin by glycemic status in patients with healed myocardial infarction (from the Coronary Drug Project). Am J Cardiol 95 254-257... 

All HMGRIs are approved for the treatment of primary hypercholesterolemia and familial combined hyperlipidemia (Fredrickson s type Ha and lib) (Table 30.2) In patients who have not responded to diet, exercise, and other non pharmacological methods (Table 30.6) (15,21). They may be used either alone or In combination with bile acid sequestrants, ezetimibe, or niacin. As previously mentioned, they should be administered at least 1 hour before or 4 to 6 hours after bile acid sequestrants when this combination Is desired. Fluvastatin, lovastatin, pravastatin, and simvastatin have been specifically Indicated to reduce the mortality of CHD and stroke. By reducing plasma LDL levels, these compounds slow the progression of atherosclerosis and reduce the risk of myocardial Infarction and other ramifications of vascular occlusion. Atorvastatin, rosuvastatin, and simvastatin have been shown to be effective In homozygous familial hyperlipidemia and are Indicated for this use. Additionally, atorvastatin, pravastatin, and simvastatin are Indicated for primary dysbetallpoprotelnemla (Fredrickson s type III) (Table 30.2). Finally, atorvastatin, pravastatin, rosuvastatin, and simvastatin are Indicated for the treatment of hypertriglyceridemia. 

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. 

Administration of nicotinic add for five years at dose of 3 g/day as monotherapy in the Coronary Drug Projed study led to marked secondary prevention of myocardial infarction (Coronary Drug Project 1975). Importantly, niacin is also being shown to have long-term benefit in decreasing mortality after discontinuation of treatment a follow-up for 15 years of Coronary Drug Project revealed that niacin decreased mortality in patients treated with niacin (Canner et al. 1986). 

The Coronary Drug Project (CDP) was a placebo-controlled secondary prevention study involving 1110 men randomized to niacin and 2789 randomized to placebo. The average daily niacin dose was 2000 mg and subjects were followed for six years. The niacin group experienced a 26% reduction in non-fatal myocardial infarctions and 24% reduction in cerebrovascular events (P <0.05 in each case) (Coronary Drug Project 1975). A 15-year follow-up study demonstrated an 11% total mortality reduction in subjects originally treated with niacin (P=0.0004) (Canner et al. 1986). 

Also, niacin is thought to III have a specific effect on growth, 121 reduce the levels of cholesterol, and (31 protect to some degree against nonfatal myocardial infarction. However, because of passible undesirable side effects, massive doses should be under the direction of a physician. 

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