The Appropriateness of Nicotinic Acid Derivative Use in Patients With the Metabolic Syndrome: Insights from the ARBITER 2 Study

Efficacy of controlled-release niacin in treatment of metabolic syndrome: Correlation to surrogate markers of atherosclerosis, vascular reactivity, and inflammation

“…Niacin has proven to be efficacious when used with other current lipid-lowering drugs, notably statins. 16 Although there has been some concern about the effects of niacin in patients with insulin resistance, 25 here we show no difference in the effects on fasting blood glucose in patients with the metabolic syndrome. While further large-scale clinical studies on the efficacy of niacin in patients with atherogenic dyslipidemia and vascular disease are ongoing, 26 results of this study suggest further benefits of raising HDL-C with niacin on the progression of atherosclerosis.…”

The effects of extended-release niacin on carotid intimal media thickness, endothelial function and inflammatory markers in patients with the metabolic syndrome

“…In the ARBITER‐2 study, investigators found a decreased progression of cIMT in patients with known coronary atherosclerosis already on statin therapy who were randomised to 1000 mg/day of extended‐release niacin for 1 year (15). Nonetheless, recent data from a post hoc analysis of this study questions these anti‐atherogenic effects of niacin in patients with insulin resistance as the positive effects on cIMT appeared to be only present in those with normal glycaemic states (16).…”

“…However, the use of niacin in patients with metabolic syndrome, an important precursor to both diabetes and cardiovascular disease, has not been well established. Furthermore, recent post hoc analysis from the ARBITER‐2 trial raised questions about the safety of niacin treatment in patients with insulin resistance (16).…”

Revisiting niacin: reviewing the evidence

“…While the investigators found decreased progression of carotid artery intima-media thickness (cIMT) in patients with known coronary atherosclerosis already on statin therapy, 50 these antiatherogenic effects of niacin appeared to be present only in those with normal glycemic states. 51 While this was a post-hoc analysis and not the primary outcome of the trial, this finding certainly warrants further investigation.…”

“…Specifically, in a subgroup analysis of patients with insulin resistance, there was no significant difference in progression of cIMT compared to statin plus placebo. 51 In the continuation of the Arterial Biology for the Investigation of the Treatment Effects of Reducing Cholesterol 2 study, the effect of extended-release niacin resulted not only in halting progression of atherosclerosis, but a significant regression of cIMT (Ϫ0.041 mm Ϯ 0.021 mm), which was independently associated by regression analysis to changes in HDL-C. 66…”