Effect of extended-release niacin on serum lipids and on endothelial function in adults with sickle cell anemia and low high-density lipoprotein cholesterol levels

Heather M. Scoffone, Megan Krajewski, Suzana Zorca, Candice Bereal-Williams, Patricia Littel, Catherine Seamon, Laurel Mendelsohn, Eleni Footman, Nadine Abi-Jaoudeh, Vandana Sachdev, Roberto F. Machado, Michael Cuttica, Robert Shamburek, Richard O. Cannon, Alan Remaley, Caterina P. Minniti, Gregory J. Kato

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6 Scopus citations

Abstract

Through bound apolipoprotein A-I (apoA-I), high-density lipoprotein cholesterol (HDL-C) activates endothelial nitric oxide synthase, inducing vasodilation. Because patients with sickle cell disease (SCD) have low apoA-I and endothelial dysfunction, we conducted a randomized, double-blinded, placebo-controlled trial to test whether extended-release niacin (niacin-ER) increases apoA-I-containing HDL-C and improves vascular function in SCD. Twenty-seven patients with SCD with levels of HDL-C <39 mg/dl or apoA-I <99 mg/dl were randomized to 12 weeks of niacin-ER, increased in 500-mg increments to a maximum of 1,500 mg/day, or placebo. The primary outcome was the absolute change in HDL-C level after 12 weeks, with endothelial function assessed before and at the end of treatment. Niacin-ER-treated patients trended to greater increase in HDL-C level compared with placebo treatment at 12 weeks (5.1 ± 7.7 vs 0.9 ± 3.8 mg/dl, 1-tailed p = 0.07), associated with significantly greater improvements in the ratios of low-density lipoprotein to HDL-C levels (1.24 vs 1.95, p = 0.003) and apolipoprotein B to apoA-I levels (0.46 vs 0.58, p = 0.03) compared with placebo-treated patients. No improvements were detected in 3 independent vascular physiology assays of endothelial function. Thus, the relatively small changes in HDL-C levels achieved by the dose of niacin-ER used in our study are not associated with improved vascular function in patients with SCD with initially low levels of apoA-I or HDL-C.

Original languageEnglish (US)
Pages (from-to)1499-1504
Number of pages6
JournalAmerican Journal of Cardiology
Volume112
Issue number9
DOIs
StatePublished - Nov 1 2013

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ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Scoffone, H. M., Krajewski, M., Zorca, S., Bereal-Williams, C., Littel, P., Seamon, C., Mendelsohn, L., Footman, E., Abi-Jaoudeh, N., Sachdev, V., Machado, R. F., Cuttica, M., Shamburek, R., Cannon, R. O., Remaley, A., Minniti, C. P., & Kato, G. J. (2013). Effect of extended-release niacin on serum lipids and on endothelial function in adults with sickle cell anemia and low high-density lipoprotein cholesterol levels. American Journal of Cardiology, 112(9), 1499-1504. https://doi.org/10.1016/j.amjcard.2013.06.035