| Abstrakt: |
We tested the hypotheses that extended-release niacin is effective for the separate treatments of abnormalities in low-density liprotein (LDL) size, high-density lipoprotein (HDL)-2, and lipoprotein(a) [Lp(a)] without potential negative effects on glycated hemoglobin levels. The lipids that constitute the atherogenic lipid profile (ALP), such as triglycerides, small, dense LDL-cholesterol particle concentration, LDL particle size, total HDL-cholesterol (HDLc), HDL-2, and HDL-2 cholesterol concentration, as well as total LDL-cholesterol (LDLc) and Lp(a), were measured in 36 diabetic patients with primary abnormalities of LDL particle size (n = 25), HDL-2 (n = 23), and/or Lp(a) (n = 12) before and after extended-release niacin treatment. LDL particle size and HDL-2 were measured using polyacrylamide gradient gel electrophoreses and Lp(a) was measured by enzyme-linked immunosorbent assay (ELISA). After extended-release niacin, LDL peak particle diameter increased from 25.2 [plusmn] 0.6 nm to 26.1 [plusmn] 0.7 nm (P[lt ] .0001); small, dense LDLc concentration decreased from 30 [plusmn] 17 mg/dL to 17 [plusmn] 10 mg/dL (P[lt ] .0001); total HDLc increased from 42 [plusmn] 9 mg/dL to 57 [plusmn] 16 mg/dL (P[lt ] .0001); HDL-2 as the percent of total HDLc mass increased from 34% [plusmn] 10% to 51% [plusmn] 17% (P[lt ] .0001); and Lp(a) decreased from 37 [plusmn] 10 mg/dL to 23 [plusmn] 10 mg/dL (P[lt ] .001). Mean hemoglobin A1clevel was improved during treatment from 7.5% [plusmn] 1.6% to 6.5% [plusmn] 0.9% (P[lt ] .0001). A subset of patients who had no change in hemoglobin A1clevels before and after treatment (6.8% [plusmn] 1% v6.7% [plusmn] 1%; not significant) showed identical lipid changes. Twenty-two percent of patients were unable to tolerate extended-release niacin due to reversible side effects. These data indicate that in diabetic patients, extended-release niacin (1) is effective for separately treating diabetic dyslipidemias associated with abnormal LDL size, HDL-2, and Lp(a) independently of glycated hemoglobin levels; (2) must be used with modern and aggressive oral hypoglycemic agents or insulin treatment; and (3) is a major drug for the treatment of diabetic dyslipidemias because of its broad spectrum of effectiveness for the ALP and Lp(a). |
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