Effects of nicotinic acid and lovastatin in renal transplant patients: A prospective, randomized, open-labeled crossover trial

Lal, Sunder M.; Hewett, John E.; Petroski, Gregory F.; Stone, Jon; Ross, Gilbert

doi:10.1016/0272-6386(95)90133-7

Cited by 30 publications

(9 citation statements)

References 22 publications

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“…88,89 Niacin monotherapy has also been shown to be effective in renal transplant patients, although side effects may limit use. 90 Cholestyramine is inadequate for monotherapy in transplant recipients. 91 Treating LT recipients may be complicated by drug interactions.…”

Section: Management After Liver Transplantmentioning

confidence: 99%

Long-Term Care of the Liver Allograft Recipient

Mells

Neuberger

2009

Semin Liver Dis

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As outcomes after liver transplant surgery continue to improve, management of the long-term consequences of the procedure and the associated immunosuppression become increasingly important. Liver allograft recipients have, compared with age and sex-matched controls, increased risk for cardiovascular and cerebrovascular events and death, for bone disease, and for some cancers. Early recognition and treatment of modifiable risk factors, especially of hypertension (present in up to 77% recipients), diabetes (in up to 22%), obesity (up to 40%), renal impairment (in up to 50%), and hyperlipidemia (in up to 66%) are necessary to maintain prolonged and healthy survival. Early recognition of de novo cancers (which occur in up to 26% recipients) indicates the need for additional monitoring for skin cancer and lymphoproliferative disorders, as well as cancers of the lung, colon, and upper gastrointestinal track. Early recognition of bone disease and appropriate intervention will allow introduction of strategies to reduce bone fracture. In this article, we review the evidence for the extent and treatment of these modifiable conditions in the allograft recipient.

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Section: Management After Liver Transplantmentioning

confidence: 99%

Long-Term Care of the Liver Allograft Recipient

Mells

Neuberger

2009

Semin Liver Dis

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“…31 A number of other, chiefly short-term, monotherapy studies in patients with dyslipidemia (but not necessarily diabetic dyslipidemia) showed that niacin tended to have modest, clinically insignificant effects on FG and other indices of glycemic regulation (Table 2). [32][33][34][35][36][37][38][39][40][41]…”

Section: Effects Of Niacin On Glucose Controlmentioning

confidence: 99%

Effects of Niacin on Glucose Control in Patients With Dyslipidemia

Goldberg

Jacobson

2008

Mayo Clinic Proceedings

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Niacin (nicotinic acid), the most effective available pharmacotherapy for increasing high-density lipoprotein cholesterol, also lowers triglycerides and hence may be useful, alone or in combination with hydroxymethylglutaryl coenzyme A reductase inhibitors (statins), to offset residual cardiovascular risk in patients with mixed or diabetic dyslipidemia. We conducted a review of published consensus guidelines since 2000 and an English-language PubMed search of prospective, randomized controlled trials and open-label studies from January 1, 1990, through December 31, 2007, concerning the effects of niacin, alone or in combination with statins, on glycemic regulation in dyslipidemic patients (with or without diabetes mellitus). For search terms, we used the title words niacin or nicotinic acid and key words including diabetes, diabetic, dyslipidemia, glucose, glycemic, HbA1c, hemoglobin, hyperglycemia, human, insulin, postprandial, and safety. Retrospective and observational studies, case reports, and case studies were excluded. On the basis of our analysis, the effects of niacin (< or =2.5 g/d), alone or in combination with statins, on fasting glucose (an increase of 4%-5%) and hemoglobin A1c levels (an increase of < or =0.3%) are modest, transient or reversible, and typically amenable to adjustments in oral hypoglycemic regimens without discontinuing niacin. Niacin therapy was infrequently associated with incident diabetes or the need for new insulin prescriptions. Studies showed important clinical benefits of niacin or niacin-statin regimens despite modest effects on glucose control. On a population basis, significant reductions in incidences of cardiovascular events and the degree of atherosclerotic progression associated with long-term niacin (or niacin-statin) therapy in patients with diabetic dyslipidemia outweigh the typically mild effects of this therapy on glycemic regulation. Consensus guidelines recommend monitoring glycemic control after initiating niacin treatment or increasing its dosage.

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“…In the case of bile acid sequestrants (resins), for example, it is well established that cholestyramine may alter the absorption of cyclosporin (22). Similarly, the dose of fibrates has to be reduced to minimize the risk of myositis, while the poor tolerability profile of nicotinic acid precludes its general use (23).…”

Section: Treatment Options For Post‐transplantation Hyperlipidaemiamentioning

confidence: 99%

“…Across all studies included in Table 1, the overall decreases in LDL‐cholesterol and total cholesterol at a fluvastatin dosage of 20–40 mg/day are 26% and 19%, respectively, which is comparable to therapeutic efficacy observed for fluvastatin in non‐transplant patients (38, 39). One study reported more modest changes in lipid parameters, which the study authors attributed to the inclusion of two patients with very high baseline total cholesterol levels (23). Increasing fluvastatin dosage from 20 to 40 mg/day further reduced LDL‐cholesterol levels by 7% in one study (34).…”

Section: Treatment Options For Post‐transplantation Hyperlipidaemiamentioning

confidence: 99%