Niacin (nicotinic acid) lowers lipids by inhibiting very-low-density lipoprotein (VLDL) production in the liver and reducing the level of VLDL that can be converted into low-density lipoprotein (LDL). Niacin can lower LDL cholesterol by 10 to 25 percent and triglyceride levels by 20 to 50 percent, and can raise levels of high density lipoprotein (HDL) cholesterol by 15 to 35 percent. These effects may be even greater in patients with a predominance of small, dense LDL, which has been associated with greater coronary heart disease risk. For these reasons, niacin is considered a useful treatment in patients with mixed dyslipidemia. The adverse effects of immediate-acting niacin preparations, including flushing, itching, gastrointestinal upset and hepatotoxicity, have limited its use. An extended-release form of niacin has to be taken nightly to minimize liver toxicity and other side effects. The daily niacin dosage can be started at 375 mg taken nightly and slowly increased, to a maximum of 3,000 mg per day, at four-week intervals for a total of 25 weeks. Patients can take 325 mg of aspirin before Niacin to prevent flushing.In peripheral vascular surgery patients HDL levels are usually low in Inida. We need to increase the HDL levels in these patients and Niacin is a good medication for these patients if the side effects such as flushing and other side effects are removed.
