Niacin

Brittany Dey, Magda Arent, Mikhaila Amres, Matheo Florez

Niacin Background
Known commonly as Vitamin B3
Derived from nicotinic acid + vitamin
Most commonly seen as niacinamide
Water soluble vitamin

Widely available in plant and animal foods:
Legumes & Seeds
Meats
Cereals
Dairy


Non-Medical Uses
Hair-Conditioning Agent
increases hair body
Improves gloss
Improves texture

Skin-Conditioning Agent
Helps dry/damaged skin
Reduce flaking
Precautions
Deficiency
Pellagra
GI Distress
Effects Central Nervous System

Overdose (highly variable, as low as 30mg):
Flushing Effect
Itching
GI Discomfort


Forms & Absorption of Niacin
Orally through tablets or capsules
Normally for pellagra or people at risk of CVD
Available in different timed release capsules
Extended-release (ER) is the most common
Given once a day ranging from 500 - 1500 mg
Released gradually throughout time
Niaspan - common brand of niacin




Cardiovascular disease is a term that refers to more than
one disease of the circulatory system including the heart
and blood vessels, whether the blood vessels are affecting
the lungs, the brain, kidneys or other parts of the body.
Cardiovascular diseases are the leading cause of death in
adult Canadian men and women


Rationale
Niacin is thought to decrease risks for CVD through
improvements in cholesterol
Helps metabolize CHO, proteins & fats
Helps maintain normal growth and development
Mechanism of Action
What is a statin?
Is a classification of drugs that are used to lower
cholesterol levels in the blood.
Helps to decrease the risk of heart attacks and stroke.
Used in studies as a method to create a baseline among
subjects.

METHODS:
N= 108, avg. age = 71 years
Aim: Examine the effects of ER niacin and atorvastin on
cholesterol & the risk of adverse events in clients with
coronary artery disease
2 groups: Group A: atorvastin (10mg/day)
Group B: 10 mg/day atorvastin + ER niacin 500 g
for 30 days
1000 mg for 12 mnths.
Follow-up: 12 mnths






Results/Conclusions
Niacin helped improve HDL-C levels
More so in patients with HDL-C >40mg/dl at admission
Agreed: combined use with ER niacin is more helpful to
overall lipid modification

Future Directions:
Clinical Cardiovascular events were not significantly
reduced in the combination therapy group
Follow up only lasted one year
Insufficient cases and dosage
METHODS:
3414 Randomly assigned patients with different forms of
CVD
Two groups: Placebo group (50mg of niacin) and
extended release niacin (1500-2000mg/day)
Double-blinded study
3 years in length
Both groups included a statin: simvastatin




Results
At 2 year mark niacin group increased median HDL
Lowered LDL and Triglycerides in both placebo and niacin
groups, but not significantly
HDL slightly raised, niacin group more so; still not
significantly
Niacin group had no significant interaction with mortality
rate

METHODS:
Randomized, double-blind, multi-centered trial, both men
and women, ages 50-80
Initial dose combination of niacin (1g) and laropiprant
(20mg) daily for 4 weeks
Doses increased after 4 weeks to 2 g of niacin and 40 mg
of laropiprant for another duration of 3-6 weeks
Study : 4 years in length
Measured LDL cholesterol and HDL cholesterol




Results/Conclusions
No significant decrease in extended-release niacin
combined with laropiprant
Significant increase in adverse effects
No significant changes in LDL and HDL


Would you recommend this? Why?
If so, who would you recommend it to?

Conclusion
No significant improvements in cholesterol when paired
with laropiprant, however some improvements when
paired with atrovastatin
Known side-effects were evident and in large quantities
Very controversial and variable

In routine clinical practice, however, combination therapy
with statin and niacin derivatives is largely underused I
fear of the increased risk of adverse events.
(Sang et al, 2009)

More research required


Questions, Comments, Concerns
References
AIM-HIGH Investigators et al.(2011). Niacin in patients with low HDL cholesterol levels receiving intensive
statin therapy. The New England Journal of Medicine, 365(24), 2255-67. doi. 10.1056/NEJMoa1107579.
Crook, M. A. (2014). The importance of recognizing pellagra (niacin deficiency) as it still occurs. Nutrition
Journal, 30(6), 729-730. doi: 10.1016/j.nut.2014.03.004
Health Canada. (2009). Monograph: Niacin. Retrieved from http://webprod.hc-sc.gc.ca/nhpid-
bdipsn/monoReq.do?id=141
HPS2-THRIVE Collaborative Group et al. (2013). Effects of extended-release niacin with laropiprant in
high-risk patients. The New England Journal of Medicine, 371 (3), 203-212. doi:101056/NEJMoa1300955.
Kamanna, V. S. & Kashyap, M. L. (2008). Mechanism of action of niacin. American Journal of Cardiology,
101(8A), 20B-26B. doi: 10.1016/j.amjcard.2008.02.029
Knopp, R. H. Et al. (1998). Equivalent efficacy of a time-release form of niacin (Niaspan) given once-a-night
versus plain niacin in the management of hyperlipidemia. Metabolism Journal, 47(9), 1097-1104. Retrived
http://www.ncbi.nlm.nih.gov/pubmed/9751239
Public Health Agency of Canada. (2013). Cardiovascular Disease. Retrieved from http://www.phac-
aspc.gc.ca/cd-mc/cvd-mcv/index-eng.php
Sang, Z., Wang, F., Zhou, Q., Li, Y., Li, Y., Wang, H., Chen, S. (2009). Combined use of extended-release
niacin and atrovastatin safety and effects on lipid modification. Chinese Medicine Journal 122(14), 1615-
1620. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/19719960
World Health Organization. (2000). Pellagra and its prevention and control in major emergencies. Retrieved
from http://www.who.int/nutrition/publications/en/pellagra_prevention_control.pdf