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Nicotinic acid increases apolipoprotein A1 levels by inhibiting the breakdown of this protein, which is a component of HDL particles. [ 35 ] [ 36 ] It also inhibits HDL-C hepatic uptake by suppressing production of the cholesterol ester transfer protein (CETP) gene. [ 28 ]
Those with higher levels of HDL-C tend to have fewer problems with cardiovascular diseases, while those with low HDL-C cholesterol levels (especially less than 40 mg/dL or about 1 mmol/L) have increased rates for heart disease. [8] [needs update] Higher native HDL levels are correlated with lowered risk of cardiovascular disease in healthy people.
At higher doses, niacin has been used to treat high cholesterol and triglyceride levels, since it can help lower LDL (“bad”) cholesterol and raise levels of HDL (“good”) cholesterol.
Niacin has sometimes been used in combination with other lipid-lowering medications. [37] Systematic reviews found no effect of niacin on cardiovascular disease or death, in spite of raising high-density lipoprotein (HDL) cholesterol. Reported side effects include an increased risk of diabetes. [38] [39] [40]
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Liver disease or kidney disease: Niacin can accumulate in people with liver or kidney problems, potentially worsening their condition. [ 1 ] Bleeding disorders : Inositol nicotinate may slow blood clotting, increasing the risk of bleeding for individuals with clotting disorders or those undergoing surgery.
Niacin therapy may reduce Lp(a) levels by 20–30%. [63] However more recent research suggests that the inflammatory effects of the breakdown products of excess niacin lead to an increase in risk of major adverse cardiovascular event. [64] A meta-analysis suggested that atorvastatin may lower Lp(a) levels. [43]