Efficacy and safety of an extended-release niacin (niaspan): a long-term study

Capuzzi, David M.; Guyton, John R.; Morgan, John; Goldberg, Anne C.; Kreisberg, Robert A.; Brusco, Osvaldo A.; Brody, Jerome I.

doi:10.1016/s0002-9149(98)00731-0

Cited by 223 publications

(153 citation statements)

References 20 publications

Supporting

Mentioning

141

Contrasting

Unclassified

Order By: Relevance

“…Evidence exists that statins can even raise Lp(a) levels. 29 Nicotinic acid has been found to lower Lp(a) by ≈40% 34,35 and to reduce cardiovascular events by ≈34%. 36 However, because more recent investigations by the HPS2-THRIVE collaborative group (Heart Protection Study 2-Treatment of HDL to Reduce the Incidence of Vascular Events) found adverse events outweighing cardiovascular risk reduction, 37,38 novel therapeutic agents like antisense oligonucleotides to apolipoprotein-B mRNA and inhibitors of the proprotein convertase subtilisin-kexin type 9 might be promising options for treatment of elevated Lp(a) levels.…”

Section: Discussionmentioning

confidence: 99%

Lipoprotein(a) Levels and Recurrent Vascular Events After First Ischemic Stroke

Lange

Nave

Liman

et al. 2017

Stroke

View full text Add to dashboard Cite

Background and Purpose— The association of elevated lipoprotein(a) (Lp(a)) levels and the incidence of cardiovascular disease, especially coronary heart disease and ischemic stroke, is well established. However, evidence on the association between Lp(a) levels and residual vascular risk in stroke survivors is lacking. We aimed to elucidate the risk for recurrent cardiovascular and cerebrovascular events in the patients with first-ever ischemic stroke with elevated Lp(a). Methods— All patients with acute ischemic stroke who participated in the prospective Berlin C&S study (Cream & Sugar) between January 2009 and August 2014 with available 12-month follow-up data and stored blood samples were eligible for inclusion. Lp(a) levels were determined in serum samples using an isoform-insensitive nephelometry assay. We assessed the risk for the composite vascular end point of ischemic stroke, transient ischemic attack, myocardial infarction, nonelective coronary revascularization, and cardiovascular death with elevated Lp(a) defined as >30 mg/dL using Cox regression analyses. Results— Of 465 C&S study participants, 250 patients were included into this substudy with a median National Institutes of Health Stroke Scale score of 2 (1–4). Twenty-six patients (10%) experienced a recurrent vascular event during follow-up. Among patients with normal Lp(a) levels, 11 of 157 subjects (7%) experienced an event at a median time of 161 days (interquartile range, 19–196 days), whereas in patients with elevated Lp(a) levels, 15 of 93 subjects (16%) experienced an event at a median time of 48 days (interquartile range, 9–194 days; P =0.026). The risk for a recurrent event was significantly higher in patients with elevated Lp(a) levels after adjustment for potential confounders (hazard ratio, 2.60; 95% confidence interval, 1.19–5.67; P =0.016). Conclusions— Elevated Lp(a) levels are associated with a higher risk for combined vascular event recurrence in patients with acute, first-ever ischemic stroke. This finding should be validated in larger, multicenter trials. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT01378468.

show abstract

Section: Discussionmentioning

confidence: 99%

Lipoprotein(a) Levels and Recurrent Vascular Events After First Ischemic Stroke

Lange

Nave

Liman

et al. 2017

Stroke

View full text Add to dashboard Cite

show abstract

“…Using dose titration to help manage adverse effects such as flushing, the dose is gradually increased by 500 mg/day or less over four weeks to reach a daily 1500 mg or 2000 mg dose for maintenance therapy (16). Despite the efficacy of ERN in achieving comprehensive lipid management and its increased tolerability over other niacin formulations (13,(18)(19)(20), therapy with ERN is frequently associated with flushing, which often undermines treatment adherence and results in a high rate of discontinuation (13,19,21).…”

mentioning

confidence: 99%

Utilization patterns of extended-release niacin in Canada: Analysis of an administrative claims database

Dorais

Chirovsky

Ambegaonkar

et al. 2010

Canadian Journal of Cardiology

View full text Add to dashboard Cite

“…In 1 long-term study, more than 40% of patients using extended-release niacin experienced flushing at treatment week 4 compared with less than 20% at week 96. 65 The mean per-patient incidence of flushing per month decreased approximately 10-fold: from 1.9 episodes to 0.19 episode.…”

Section: Clinical Trials Of Niacin Monotherapy: 1985-1999mentioning

confidence: 98%

“…Studies summarized in eTable 1 [65][66][67][68][69][70][71][72][73] (available online, linked to this article) evaluated the effects of niacin monotherapy on surrogate (lipid or lipoprotein) end points and patient-related flushing per se (ie, flush provocation studies). In 1 long-term study, more than 40% of patients using extended-release niacin experienced flushing at treatment week 4 compared with less than 20% at week 96.…”

Section: Clinical Trials Of Niacin Monotherapy: 1985-1999mentioning

confidence: 99%

A “Hot” Topic in Dyslipidemia Management—“How to Beat a Flush”: Optimizing Niacin Tolerability to Promote Long-term Treatment Adherence and Coronary Disease Prevention

Jacobson

2010

Mayo Clinic Proceedings

View full text Add to dashboard Cite

Niacin is the most effective lipid-modifying agent for raising highdensity lipoprotein cholesterol levels, but it also causes cutaneous vasodilation with flushing. To determine the frequency of flushing in clinical trials, as well as to delineate counseling and treatment approaches to prevent or manage flushing, a MEDLINE search was conducted of English-language literature from January 1, 19851, , through April 7, 2009. This search used the title keywords niacin or nicotinic acid crossed with the Medical Subject Headings adverse effects and human. Niacin flushing is a receptormediated, mainly prostaglandin D 2 -driven phenomenon, the frequency, onset, and duration of which are largely determined by the distinct pharmacological and metabolic profiles of different niacin formulations. Subjective assessments include ratings of redness, warmth, itching, and tingling. In clinical trials, most (>60%) niacin users experienced mild or moderate flushing, which tended to decrease in frequency and severity with continued niacin treatment, even with advancing doses. Approximately 5% to 20% of patients discontinued treatment because of flushing. Flushing may be minimized by taking niacin with meals (or at bedtime with a low-fat snack), avoiding exacerbating factors (alcohol or hot beverages), and taking 325 mg of aspirin 30 minutes before niacin dosing. The current review advocates an initially slow niacin dose escalation from 0.5 to 1.0 g/d during 8 weeks and then from 1.0 to 2.0 g in a single titration step (if tolerated). Through effective counseling, treatment prophylaxis with aspirin, and careful dose escalation, adherence to niacin treatment can be improved significantly. Wider implementation of these measures should enable higher proportions of patients to reach sufficient niacin doses over time to prevent cardiovascular events. Proc. 2010;85(4):365-379 GPR = G i protein-coupled receptor; HDL-C = high-density lipoprotein cholesterol; NSAID = nonsteroidal anti-inflammatory drug; PG = prostaglandin; RCT = randomized controlled trial R educing low-density lipoprotein cholesterol levels is the primary treatment for preventing cardiovascular disease, largely because of robust evidence from randomized controlled trials (RCTs) involving statins. Mayo Clin

show abstract

Efficacy and safety of an extended-release niacin (niaspan): a long-term study

Cited by 223 publications

References 20 publications

Lipoprotein(a) Levels and Recurrent Vascular Events After First Ischemic Stroke

Lipoprotein(a) Levels and Recurrent Vascular Events After First Ischemic Stroke

Utilization patterns of extended-release niacin in Canada: Analysis of an administrative claims database

A “Hot” Topic in Dyslipidemia Management—“How to Beat a Flush”: Optimizing Niacin Tolerability to Promote Long-term Treatment Adherence and Coronary Disease Prevention

Contact Info

Product

Resources

About