Niacin: from mechanisms of action to therapeutic uses.

Niacin has broad spectrum lipid modifying and anti-atherosclerotic properties. It is the most effective medication available for raising raise high density lipoprotein (HDL) levels. Despite statin therapy there remains a considerable residual cardiovascular risk attributed to low HDL levels. Currently, statins decrease cardiovascular events and death by about 25-40%. Trials with surrogate endpoints have shown a decrease in endpoints by 60-90% when a combination of statin and niacin has been used. There is a growing interest in niacin in combination therapy to fill the treatment gap by modifying lipid parameters other than low density lipoprotein cholesterol. This review addresses the role of niacin in comprehensive lipid management with an emphasis on its mechanism of action, formulations, side effects, evidence from clinical trials and also focuses on practical issues related to niacin therapy.