Effects of Niacin on LDL Particle Number

Haseeb Jafri; Richard H Karas; Jeffrey T Kuvin

Disclosures

Clin Lipidology. 2009;4(5):565-571. 

In This Article

Future Perspective

It is clear that niacin is a broad-spectrum lipid-altering medication with substantial cardiovascular benefit. Multiple randomized, placebo-controlled trials have demonstrated niacin's ability to positively influence both angiographic and clinical outcomes.[19–22] In addition to its lipid profile effects, ERN has beneficial effects on endothelial function as well as on inflammatory markers.[13,14] Furthermore, it is clear that there is an association between LDL-P (total, large and small) and cardiovascular outcomes.[27–32] Guidelines from the ACC and the ADA suggest that measurement of LDL-P may be a more accurate way to assess cardiovascular risk in addition to the standard lipid profile.[24] Newer research with niacin, and more specifically ERN, indicates that therapy with ERN favorably alters these particle numbers, thereby potentially reducing cardiovascular risk.[15–18] Of note, however, the additional value of LDL-P is still under debate and although potentially interesting and insightful, it is not generally recommended for routine analysis at this time.

Given this information, there remains a key question: will ERN's ability to change LDL-P result in a measurably favorable change in cardiovascular outcomes? The ongoing Atherothrombosis Intervention in Metabolic Syndrome with Low HDL/High Triglycerides and Impact on Global Health Outcomes (AIM-HIGH) study should assist in answering this important question. This study is planned to randomize approximately 3300 people to either simvastatin or simvastatin–niacin over the course of 5–6 years.[101] The premise of the study is that, even with statin therapy and well-controlled LDL-C levels, there remains an unacceptably high risk of cardiovascular events. This residual risk may be attributable to multiple factors, including low levels of HDL-C and high numbers of small, or total LDL-Ps. This analysis will be an essential step to addressing ERN's ability to affect outcomes via its changes in LDL-P.

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