Use of Nicotinic Acid, Bile Acid-Binding Resins, and Fibrates
Although this article focuses on nicotinic acid, niacin has successfully been used to treat high cholesterol levels safely. This is a very good review covering the different types of niacin available. And, interestingly, the author notes that nicotinic acid has the longest history of use; and yet most doctors and patients are unaware of its benefits.
Clin Rev Spring:52-57, 2000 Nicotinic acid and nicotinamide together represent the essential vitamin niacin in the diet. Of these two, only nicotinic acid is active as a lipid-modifying drug. Thus, while nicotinamide is often marketed as a superior lipid-lowering version of niacin with none of the unpleasant side effects of nicotinic acid, such as flushing and itching, in truth this compound is totally ineffective as a lipid-lowering drug. The recommended dietary allowance of niacin is less than 20 mg/day. Pharmacologically effective doses of nicotinic acid begin at 1,000 to 2,000 mg/day and range up to an effective maximum of 6,000 mg/day. In 1955, this dose range of nicotinic acid was shown to lower total serum cholesterol, and in 1961 it was shown to lower triglyceride and low-density lipoprotein (LDL) cholesterol levels and raise high-density lipoprotein (HDL) levels in hyperlipidemic patients. Thus, of the drugs currently available for treating hyperlipidemia, nicotinic acid has been used the longest. Over the past 40 years, nicotinic acid has been used in numerous clinical trials and has been proven to reduce lipids and prevent and/or reverse coronary artery disease. In 1988 the National Cholesterol Education Program’s (NCEP) Adult Treatment Panel recommended nicotinic acid as a drug of first choice.