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2000, Número 4

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Arch Cardiol Mex 2000; 70 (4)


Eficacia y seguridad de la niacina de liberación inmediata en pacientes con cardiopatía isquémica. Experiencia del Instituto Nacional de Cardiología “Ignacio Chávez”

Morato HML, Sagrario ICM, Alvarado VAG, Zamora GJ, Cardoso SGC, Posadas RC

Idioma: Español
Referencias bibliográficas: 49
Paginas: 367-376
Archivo PDF: 183.01 Kb.


RESUMEN

Los estudios de prevención primaria y secundaria han demostrado que la niacina mejora el perfil de lípidos y reduce la morbimortalidad coronaria. Objetivo: Investigar la eficacia y seguridad de la niacina en dosis de 1.5 y 3.0 g al día en pacientes con cardiopatía isquémica y dislipidemia. Material y métodos: Se incluyeron 61 pacientes de ambos sexos y con edades de 30 a 70 años. Se eliminaron 32 pacientes: 18 por reacciones adversas y 14 por motivos no relacionados con el fármaco. Resultados: En los 29 pacientes que terminaron el estudio, la niacina produjo reducciones significativas, dependientes de dosis, en las concentraciones de colesterol total, C-LDL, triglicéridos, apolipoproteína B y la relación C-LDL/CHDL y aumentó de manera significativa el nivel de C-HDL. La lipoproteína(a) disminuyó con ambas dosis, pero sólo alcanzó significado estadístico con la dosis de 3.0 g. En once pacientes (38%), las variables del perfil lipoproteico alcanzaron los valores ideales, y en 15 pacientes (52%), la relación C-LDL/C-HDL fue menor o igual a 3.5 al final del tratamiento. Conclusiones: Los resultados indican que la niacina es tolerada por el 62% de los pacientes; por tanto, constituye una alternativa terapéutica efectiva y de bajo costo.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. National Cholesterol Education Program Expert Panel: Summary of the second report of the national cholesterol education program (NCEP) expert panel on detection, evaluation and treatment of high blood cholesterol in adults (Adult treatment panel II). JAMA 1993; 269: 3015-3023.

  2. Goldbourt U, Yaari S, Medalie JH. Isolated low HDL cholesterol as a risk factor for coronary heart disease mortality. A 21-year follow-up of 8000 men. Arterioscler Thromb Vasc Biol 1997; 17: 107-113.

  3. Shepherd J, Cobbe SM, Ford I, Isles CG, Lorimer AR, MacFarlane PW, et al: For the West of Scotland Coronary Prevention Study Group: Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. N Engl J Med 1995; 333: 1301-1307.

  4. Downs JR, Clearfield M, Weis S, Whitney E, Shapiro DR, Beere PA, et al: Primary prevention of acute coronary events with lovastatin in men and women with average cholesterol levels: Results of AFCAPS/TexCAPS. Air Force/Texas Coronary Atherosclerosis Prevention Study. JAMA 1998; 279: 1615-1622.

  5. Scandinavian Simvastatin Survival Study Group: Randomized trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet 1994; 344: 1383-1389.

  6. Sacks FM, Pfeffer MA, Moye LA, Rouleau JL, Rutherford JD, Cole TG, et al: For the Cholesterol and Recurrent Events Trial investigators: The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. N Engl J Med 1996; 335: 1001-1009.

  7. Altschul R, Hoffer A, Stephen JD: Influence of nicotinic acid on serum cholesterol in man. Arch Biochem Biophys 1955; 54: 558-559.

  8. Grundy SM: Management of high serum cholesterol and related disorders in patients at risk for coronary heart disease. Am J Med 1997; 102(2A): 15-22.

  9. Gray DR, Morgan T, Chretien SD, Kashyap ML: Efficacy and safety of controlled-release niacin in dyslipoproteinemic veterans. Ann Intern Med 1994; 121: 252-258.

  10. Knopp RH, Ginsberg J, Albers JJ, Hoff C, Ogilvie JT, Warnick GR, et al: Contrasting effects of unmodified and time-release forms of niacin on lipoproteins in hyperlipidemic subjects: Clues to mechanism of action of niacin. Metabolism 1985; 34: 642-650.

  11. McKenney JM, Proctor JD, Harris S, Chinchili VM: A Comparison of the efficacy and toxic effects of sustained-vs immediate-release niacin in hvpercholesterolemic patients. JAMA 1994; 271: 672-677.

  12. Grundy SM: Cholesterol management in patients with heart disease. Postgrad Med 1997; 102: 81-90.

  13. Grundy SM: Atherogenic dyslipidemia: lipoprotein abnormalities and implications for therapy. Am J Cardiol 1995; 75-45B-52B.

  14. Henkin Y, Oberman A, Hurst DC, Segrest JP: Niacin Revisited: clinical observations on an important but underutilized drug. Am J Med 1991; 91: 239-246.

  15. Martin-Jadraque R, Tato F, Mostaza JM, Vega GL, Grundy SM: Effectiveness of low-dose crystalline nicotinic acid in men with low high-density lipoprotein cholesterol levels. Arch Intern Med 1996; 156: 1081-1088.

  16. Knopp RH, Alagona P, Davidson M, Goldberg AC, Kafonek SD, Kashyap M, et al: Equivalent efficacy of a time-release form of niacin (niaspan) given once-a-night versus plain niacin in the management of hyperlipidemia. Metabolism 1998; 47: 1097-1104.

  17. Wahlberg G, Holmquist L, Walldius G, Annuzzi G: Effects of nicotinic acid on concentrations of serum apolipoproteins B, CI, CII, CIII and E in hyperlipidemic patients. Acta Med Scand 1988; 224: 319-327.

  18. Carlson LA, Hamsten A, Asplund A: Pronounced lowering of serum levels of lipoprotein Lp(a) in hyperlipidaemic subjects treated with nicotinic acid. J Intern Med 1989; 226: 271-276.

  19. Superko HR, Krauss RM: Differential effects of nicotinic acid in subjects with different LDL subclass patterns. Atherosclerosis 1992; 95: 69-76.

  20. Canner PL, Berge KG, Wenger NK, Stamler J, Friedman L, Prineas RJ, et al: Fifteen year mortality in coronary drug project patients: long-term benefit with niacin. J Am Coll Cardiol 1986; 8: 1245-1255.

  21. Cashin-Hemphil L, Mack W, Pogoda J, Sanmarco ME, Azen P, Blankenhorn DH: Beneficial effects of colestipol-niacin on coronary atherosclerosis. 4 yeas follow-up. JAMA 1990; 264: 3013-3017.

  22. De Long DA, Weed Pd: A comparison of methods for the estimation of plasma low and very low-density lipoprotein cholesterol. JAMA 1986; 226: 2372-2377.

  23. Cazzolato G, Prakasch G, Green S, Kostner GM: The determination of lipoprotein Lp(a) by rate and endpoint nephelometry. Clin Chim Acta 1983; 135: 203-208.

  24. Assmann G, Schulte H: Relation of high-density lipoprotein cholesterol and triglycerides to incidence of atherosclerotic coronary artery disease (the PROCAM experience). Prospective Cardiovascular Münster study. Am J Cardiol 1992; 70: 733-737.

  25. Knopp RH: Drug treatment of lipid disorders. N Engl J Med 1999; 341: 498-511.

  26. Kruse W, Raetzer H, Heuck CC, Oster P, Schellenberg B, Schlierf G: Nocturnal inhibition of lipolysis in man by nicotinic acid and derivatives. Eur J Clin Pharmacol 1979; 16: 11-15.

  27. Grundy SM, Mok HY, Zech L, Berman M: Influence of nicotinic acid on metabolism of cholesterol and triglycerides in man. J Lip Res 1981; 22: 24-36.

  28. Jin FY, Kamanna VS, Chuang MY, Morgan K, Kashyap ML: Gemfibrozil stimulates apolipoprotein A-I synthesis and secretion by stabilization of mRNA transcripts in human hepatoblastoma cell line (Hep G2). Arterioscler Thromb Vasc Biol 1996; 16: 1052-1062.

  29. Saku K, Gartside PS, Hynd BA, Kashyap ML: Mechanism of action of gemfibrozil on lipoprotein metabolism. J Clin lnvest 1985; 75: 1702-1712.

  30. Ginsberg HN, Ngaic, Ramakrishnan R: Lovastatin increases apolipoprotein A-I levels in subjects with isolated reductions in high density lipoproteins. (Abstract). Circulation 1991; 84: 11-140.

  31. Schaefer JR, Schweer H, Ikewaki, Stracke H, Seyberth HJ, Kaffarnik H, et al: Metabolic basis of high density lipoproteins and apolipoprotein A-I increase by HMG-CoA reductase inhibition in healthy subjects and a patient with coronary artery disease. Atherosclerosis 1999; 144: 177-184.

  32. Blum CB, Levy RI, Eisenberg S, Hall M III, Goebel RH, Berman M: High density lipoprotein metabolism in man. J Clin Invest 1977; 60: 795-807.

  33. Shepherd J, Packard CJ, Patsch JR, Gotto AM Jr, Taunton OD: Effects of nicotinic acid therapy on plasma high-density lipoprotein subfraction distribution and composition and on apolipoprotein A metabolism. J Clin Invest 1979; 63: 858-867.

  34. Kashyap ML: Mechanistic studies of high-density lipoproteins. Am J Cardiol 1998; 82: 42U-48U.

  35. Acton S, Rigotti A, Landschuiz KT, Xu S, Hobbs HH, Krieger M: Identification of scavenger receptor SR-BI as a high density lipoprotein receptor. Science 1996; 271: 518-520.

  36. Multiple Risk Factor Intervention Trial Research Group: Relationship between baseline risk factors and coronary heart disease and total mortality in the Multiple Risk Factor Intervention Trial. Prev Med 1986; 15: 254-273.

  37. Manninen V, Elo MO, Frick MH, Haapa K, Heinonen OP, Heinsalmi P, et al: Lipid alterations and decline in the incidence of coronary heart disease in the Helsinki Heart Study. JAMA 1988; 260: 641-651.

  38. Rubins HB, Robins SJ, Collins D, Fye CL, Anderson JW, Elam MB, et al: Gemfibrozil for the secondary prevention of coronary heart disease in men with low levels of high-density lipoprotein cholesterol. Veterans Affairs High Density Lipoprotein Cholesterol Intervention Trial Study Group. N Engl J Med 1999; 341: 410-418.

  39. Parthasarathy S, Barnett J, Fong LG: High-density lipoprotein inhibits the oxidative modification of low-density lipoprotein. Biochim Biophys Acta 1990; 1044: 275-283.

  40. Havel RJ, Kane JP, Kashyap ML: Interchange of apolipoproteins between chylomicrons and high density lipoproteins during alimentary lipemia in man. J Clin Invest 1973; 52: 32-38.

  41. Chait A, Brazg RL, Tribble DL, Krauss RM: Susceptibility of small, dense, low-density lipoproteins to oxidative modification in subjects with the atherogenic lipoprotein phenotype, Pattern B. Am J Med 1993; 94: 350-356.

  42. Brown SL, Sobel BE, Fujii S: Attenuation of the synthesis of plasminogen activator inhibitor type 1 by niacin. A Potential link between lipid lowering and fibrinolysis. Circulation 1995; 92: 767-772.

  43. Coates P, Shuttleworth D, Rees A: Resolution of nicotinic acid-induced acanthosis nigricans by substitution of an analogue (acipimox) in a patient with type V hyperlipidaemia. Br J Dermatol 1992; 126: 412-414.

  44. Gibbons LW, González V, Gordon N, Grundy S: The prevalence of side effects with regular and sustained-release nicotinic acid. Am J Med 1995; 99: 378-385.

  45. The Coronary Drug Project Research Group: Clofibrate and niacin in coronary heart disease. JAMA 1975; 231: 360-381.

  46. Insel PA: Analgesic-antipyretics and antiinflammatory agents: Drugs employed in the treatment of rheumatoid arthritis and gout. In Goodman Gilman A, Rall TW, Nies AS, Taylor P. The pharmacological basis of therapeutics. 8th edition. Singapore. McGraw-Hill ed. 1991; 1: 638-681.

  47. Kahn SE, Beard JC, Schwartz NW, Ward WK, Ding HL, Bergman RN, et al: Increase beta-cell secretory capacity as mechanism for islet adaptation to nicotinic acid-induced insulin resistance. Diabetes 1989; 38: 562-568.

  48. Garg A, Grundy SM: Nicotinic acid as therapy for dyslipidemia in non-insulindependent diabetes mellitus. JAMA 1990; 264: 723-726.

  49. Gaut ZN, Pocelinko R, Solomon HM, Thomas GB: Oral glucose tolerance, plasma insulin and uric acid excretion in man during-chronic administration of nicotinic acid. Metabolism 1971; 20: 1031-1035.




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