Niacin Alternatives for Dyslipidemia: Fool's Gold or Gold Mine? Part I: Alternative Niacin Regimens.
Niacin Alternatives for Dyslipidemia: Fool's Gold or Gold Mine? Part I: Alternative Niacin Regimens.
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DOI：
10.1007/s11883-016-0563-8
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发表时间：
2016-02
影响因子：
5.8
通讯作者：
Goel H
中科院分区：
文献类型：
--
作者：
Dunbar RL;Goel H
烟酸是第一种证明降低胆固醇可预防冠心病（CHD）事件的药物，两项临床CHD结局研究建立了一种心脏保护性烟酸方案：1 g每日三次，随餐服用。虽然烟酸具有心脏保护作用，但皮肤毒性限制了烟酸的使用，促进了几种变化以提高耐受性。其中之一，延长释放（ER）的替代品，被证明是非常成功的商业，主导临床实践，尽管在几个关键方面偏离了既定的方案。因此，提高耐受性可能是以降低疗效为代价的，这就提出了一个难题：通过“稀释”来扩大药物的接受度是否仍然有助于冠心病风险人群？这个问题在现阶段是至关重要的，因为ER替代方案未能在替代方法的两项试验中重现已建立的心脏保护烟酸方案的益处：AIM-HIGH和HPS 2-THRIVE。本综述的第一部分讨论了ER替代方案与已建立的心脏保护方案的差异有多大，为什么这在生理上很重要，以及它如何解释AIM-HIGH和HPS 2-THRIVE的发现。鉴于他汀类药物治疗留下的重要空白，已建立的心脏保护性烟酸方案仍然是他汀类药物不耐受或他汀类药物厌恶者的重要循证治疗。本文的在线版本（doi：10.1007/s11883-016-0563-8）包含补充材料，可供授权用户使用。
Niacin was the first drug demonstrating lowered cholesterol prevents coronary heart disease (CHD) events, with two clinical CHD outcome studies establishing a cardioprotective niacin regimen: 1 g thrice daily with meals. Though cardioprotective, skin toxicity limits niacin’s use, fostering several variations to improve tolerability. One of these, an extended-release (ER) alternative, proved immensely successful commercially, dominating clinical practice despite departing from the established regimen in several critical ways. Hence, improved tolerability may have come at the cost of diminished efficacy, posing a conundrum: Does it still help the population at risk for CHD to broaden a drug’s acceptance by “watering it down”? This question is crucial at this stage now that the ER alternative failed to recapitulate the benefits of the established cardioprotective niacin regimen in two trials of the alternative approach: AIM-HIGH and HPS2-THRIVE. Part I of this review discusses how vastly the ER alternative departs from the established cardioprotective regimen, why that is important physiologically, and how it may explain the findings of AIM-HIGH and HPS2-THRIVE. Given important gaps left by statin therapy, the established cardioprotective niacin regimen remains an important evidence-based therapy for the statin intolerant or statin averse. The online version of this article (doi:10.1007/s11883-016-0563-8) contains supplementary material, which is available to authorized users.