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Published Online, 30 December 2003, www.theannals.com, DOI 10.1345/aph.1D218.
 The Annals of Pharmacotherapy: Vol. 38, No. 2, pp. 277-285. DOI 10.1345/aph.1D218
© 2004 Harvey Whitney Books Company.
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CARDIOLOGY

The Metabolic Syndrome: Pathophysiology, Clinical Relevance, and Use of Niacin

Matthew K Ito, PharmD FCCP BCPS

Professor and Vice Chair of Pharmacy Practice, Thomas J Long School of Pharmacy and Health Sciences, University of the Pacific, Stockton, CA; Director, Cardiac Rehabilitation Cholesterol Clinic, Department of Pharmacy (119), Veterans Affairs San Diego Health Care System, 3350 La Jolla Village Dr., San Diego, CA 92161-0002, fax 858/552-7582, uopito{at}aol.com

Reprints: Matthew K Ito PharmD FCCP BCPS

OBJECTIVE: To review the pathophysiology and clinical relevance for using niacin to treat the metabolic syndrome.

DATA SOURCES: Primary articles were identified through a MEDLINE search (1966-January 2003), and recommendations for treatment were obtained from the National Cholesterol Education Program Adult Treatment Panel (NCEP-ATP) III guidelines.

STUDY SELECTION AND DATA EXTRACTION: Published studies showing the effects of the metabolic syndrome, atherogenic dyslipidemia, and niacin were evaluated and reviewed.

DATA SYNTHESIS: The metabolic syndrome is a highly prevalent condition that affects 24% of American adults and significantly increases the risk of coronary heart disease (CHD). Most patients with metabolic syndrome have atherogenic dyslipidemia characterized by elevated triglycerides, low high-density-lipoprotein cholesterol (HDL-C), and small, dense low-density-lipoprotein cholesterol (LDL-C) particles. The NCEP-ATP III identifies patients with the metabolic syndrome as candidates for intensified therapy. Lifestyle modifications and drug therapy are recommended. Niacin represents a good option for treating the triad of lipid abnormalities seen in the metabolic syndrome because it raises HDL-C, lowers triglycerides, and increases LDL-C particle size.

CONCLUSIONS: Treatment of the metabolic syndrome is recommended by NCEP-ATP III to further reduce CHD risk after the LDL-C target has been met. Prospective clinical studies are needed to define the impact of niacin and other lipid-modifying agents on CHD morbidity and mortality in patients with the metabolic syndrome.

Key Words: atherogenic dyslipidemia, HDL-cholesterol, LDL particle size, metabolic syndrome, niacin, triglycerides

Published Online, December 30, 2003. www.theannals.com, DOI 10.1345/aph.1D218

THIS ARTICLE IS APPROVED FOR CONTINUING EDUCATION CREDIT
ACPE UNIVERSAL PROGRAM NUMBER: 407-000-04-006-H01




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