Niacin and Lipoprotein(a): Facts, Uncertainties, and Clinical Considerations

Over the years, niacin has gained recognition as an atheroprotective agent, in part because of its capacity to lower the plasma levels of cholesterol, triglycerides, and very-low- and low-density lipoproteins and to substantially raise high-density lipoprotein. In high doses, niacin has also been reported to lower the plasma level of lipoprotein(a) (Lp[a]). However, the published research on the subject suffers from a lack of uniformity regarding patient selection, drug dose, length of administration, and methods for plasma Lp(a) quantification. In this report, the authors examine the most relevant niacin-related Lp(a) studies and hypothetical mechanisms of drug action, also considering the emerging notion of Lp(a) as a potential proinflammatory entity.