Carlson L A
King Gustaf V Research Institute, Karolinska Institutet, Stockholm, Sweden.
J Intern Med. 2005 Aug;258(2):94-114. doi: 10.1111/j.1365-2796.2005.01528.x.
Nicotinic acid has, like the Roman God Janus, two faces. One is the vitamin. The other is the broad-spectrum lipid drug. The Canadian pathologist Rudolf Altschul discovered 50 years ago that nicotinic acid in gram doses lowered plasma levels of cholesterol. From the point of view of treatment of the dyslipidaemias that are risk factors for clinical atherosclerosis nicotinic acid is a miracle drug. It lowers the levels of all atherogenic lipoproteins--VLDL and LDL with subclasses as well as Lp(a)--and in addition it raises more than any other drug the levels of the protective HDL lipoproteins. Trials have shown that treatment with nicotinic acid reduces progression of atherosclerosis, and clinical events and mortality from coronary heart disease. The new combination treatment with statin-lowering LDL and nicotinic acid-raising HDL is reviewed. A basic effect of nicotinic acid is the inhibition of fat-mobilizing lipolysis in adipose tissue leading to a lowering of plasma free fatty acids, which has many metabolic implications which are reviewed. The very recent discovery of a nicotinic acid receptor and the finding that the drug stimulates the expression of the ABCA 1 membrane cholesterol transporter have paved the way for exciting and promising new 50 years in the history of nicotinic acid.
烟酸如同罗马神话中的两面神亚努斯一样，有两张面孔。一面是维生素，另一面是一种广谱脂质药物。50年前，加拿大病理学家鲁道夫·阿尔茨舒尔发现，大剂量的烟酸能降低血浆胆固醇水平。从治疗作为临床动脉粥样硬化危险因素的血脂异常的角度来看，烟酸是一种神奇的药物。它能降低所有致动脉粥样硬化脂蛋白的水平——极低密度脂蛋白（VLDL）及其亚类、低密度脂蛋白（LDL）以及脂蛋白（a）[Lp(a)]，此外，与其他任何药物相比，它能更有效地提高具有保护作用的高密度脂蛋白（HDL）的水平。试验表明，烟酸治疗可减缓动脉粥样硬化的进展，并降低冠心病的临床事件和死亡率。本文对降低低密度脂蛋白的他汀类药物与升高高密度脂蛋白的烟酸联合新疗法进行了综述。烟酸的一个基本作用是抑制脂肪组织中促使脂肪分解的脂解作用，从而导致血浆游离脂肪酸水平降低，这具有许多代谢方面的影响，本文对此也进行了综述。最近发现了一种烟酸受体，并且发现该药物能刺激ABCA 1膜胆固醇转运蛋白的表达，这为烟酸历史上激动人心且充满希望的新50年铺平了道路。
