Martin-Jadraque R, Tato F, Mostaza J M, Vega G L, Grundy S M
Center for Human Nutrition, University of Texas Southwestern Medical Center, Dallas, USA.
Arch Intern Med. 1996 May 27;156(10):1081-8.
Hypoalphalipoproteinemia (low serum concentration of high-density lipoprotein cholesterol [HDL-C]) is a common pattern of dyslipidemia associated with coronary heart disease. High doses of nicotinic acid effectively raise HDL-C levels in this condition, but they are commonly accompanied by side effects. The efficacy of low doses of nicotinic acid that may produce fewer side effects has not been adequately studied.
To determine the effects of low-dose nicotinic acid on HDL-C levels in patients with hypoalphalipoproteinemia.
Forty-four men with low HDL-C levels (< 1.03 mmol/L [< 40 mg/dL]) entered the study. Twenty-four patients otherwise had normal lipid levels, and 20 were moderately hypertriglyceridemic (range of plasma triglyceride levels, 2.82 to 5.64 mmol/L 250 to 500 mg/dL). The trial consisted of 3 phases; each phase lasted 8 weeks. The first phase was diet only (30% fat diet); in the second phase, crystalline nicotinic acid was added at 1.5 g/d; and in the third phase, the dose was increased to 3 g/d.
Of the 44 patients who entered the study, 37 completed the low-dose phase (1.5 g/d); the remaining patients were withdrawn because of side effects to nicotinic acid. Four other patients who completed the low-dose phase were excluded from the higher dose phase because of side effects that developed when they were receiving the low dose. Ten other patients withdrew during the high-dose phase because of side effects. In both groups, responses to nicotinic acid therapy tended to be dose-dependent. For both groups, the higher dose generally produced a greater reduction in apolipoprotein B-containing lipoproteins and a greater rise in HDL-C levels. However, for both groups, the low dose of nicotinic acid gave an average 20% increase in HDL-C levels.
A low dose (1.5 g/d) of crystalline nicotinic acid causes an average 20% increase in HDL-C levels and significantly lowers triglyceride levels in both normolipidemic and hyperlipidemic patients with low HDL-C levels. Although the changes induced by this dose are less than those that can be achieved by a higher dose, the lower dose is better tolerated. Nicotinic acid may be useful in combined drug therapy for secondary prevention of coronary heart disease, and if higher doses cannot be tolerated, use of a lower dose should still be useful for producing a moderate rise in HDL-C levels in patients with hypoalphalipoproteinemia.
低α脂蛋白血症（血清高密度脂蛋白胆固醇[HDL-C]浓度降低）是一种与冠心病相关的常见血脂异常模式。高剂量烟酸可有效提高此类患者的HDL-C水平，但通常会伴有副作用。低剂量烟酸可能产生较少副作用，但其疗效尚未得到充分研究。
确定低剂量烟酸对低α脂蛋白血症患者HDL-C水平的影响。
44名HDL-C水平较低（<1.03 mmol/L [<40 mg/dL]）的男性进入该研究。另外24名患者血脂水平正常，20名患者中度高甘油三酯血症（血浆甘油三酯水平范围为2.82至5.64 mmol/L [250至500 mg/dL]）。试验包括3个阶段；每个阶段持续8周。第一阶段仅采用饮食控制（30%脂肪饮食）；第二阶段，添加结晶烟酸，剂量为1.5 g/d；第三阶段，剂量增加至3 g/d。
在进入研究的44名患者中，37名完成了低剂量阶段（1.5 g/d）；其余患者因烟酸副作用而退出。另外4名完成低剂量阶段的患者因在接受低剂量时出现副作用而被排除在高剂量阶段之外。另外10名患者在高剂量阶段因副作用而退出。在两组中，对烟酸治疗的反应均呈剂量依赖性。对于两组而言，较高剂量通常能使含载脂蛋白B的脂蛋白有更大程度的降低，HDL-C水平有更大程度的升高。然而，对于两组而言，低剂量烟酸使HDL-C水平平均升高20%。
低剂量（1.5 g/d）结晶烟酸可使HDL-C水平平均升高20%，并显著降低HDL-C水平较低的血脂正常和高脂血症患者的甘油三酯水平。尽管该剂量引起的变化小于高剂量所能达到的变化，但较低剂量的耐受性更好。烟酸可能对冠心病二级预防的联合药物治疗有用，如果不能耐受高剂量，使用较低剂量仍有助于使低α脂蛋白血症患者的HDL-C水平适度升高。
