Niacin:

Re-emergence of an Old Player and Gatekeeper of Emerging Metabolic Pathways and Therapeutic Interventions

From the "Nutraceuticals’ Role in Metabolic and Cardiovascular Disease" webinar

I. Background

1. What are nutraceuticals?

a. Brief historical perspective of the use of nutraceuticals
b. Nutraceutical/Functional Foods vs. pharmaceuticals: Current definitions
c. Table to demonstrate a list of nutraceuticals and show cumulative % effects on triglycerides (as example)

2. Vitamin vs. pharmacological properties of niacin

a. Vitamin – Pellagra
b. Pharmacological

i. First agent used to treat cholesterol in humans (1955)

3. Forms of Niacin

a. Over-the-counter

i. Immediate release
ii. Sustained release
iii. Extended release

b. Prescription formulations

4. Adverse effects

a. Flushing – Niacin receptor activation
b. GI
c. Fatigue

II. Basic Science

1. Signaling events that regulate the breakdown of lipids within fat cells
2. Target tissues

a. Adipose tissue

i. Lipolytic response to niacin

b. Liver

i. Emerging evidence

3. Effects of niacin on blood lipid metabolism

a. Primary effects on HDL-C and triglycerides
b. Effects on LDL-C

4. Emerging effects of niacin beyond lipid metabolism

III. Clinical Research/Applications

1. Clinical Trials

a. Classic and emerging evidence for niacin
b. Effects on morbidity and mortality

i. Decrease non-fatal MI and cardiac death

2. Other nutraceutical and pharmacologicals being developed

a. Adiopose tissue receptor agonists
b. Combination nutraceutical/pharmaceutical therapies
c. Combination with aerobic exercise

Behavioral/Learning Objectives:

1. Describe the various formulations of niacin and describe adverse effects associated with niacin.
2. Describe the proposed mechanisms by which niacin works in its target tissues.
3. Explain the non-lipid lowering effects of niacin and the potential contribution to cardiovascular disease risk reduction.