Introduction

Cardiovascular diseases are a major cause of morbidity and mortality worldwide. The incidence of coronary heart disease (CHD) in Pakistan is as high as in western Pakistan world1 46% of cardiac deaths are on myocardial infarction and 23% die from other subsets of ischemic heart disease .70% of these patients before medical assistance is available to them. Major risk factors with coronary heart disease, sex, age, smoking cigrete, diabetes mellitus, hypertension and hyperlipidemia.13 A level of HDL-C, independent of LDL-C level, also associated factor CHD.Moreover great risk for a significant proportion of patients with CHD have low HDL-C concentrations.4, 19-20

There are several medications that lower total cholesterol, triglycerides, LDL-C and raising HDL-C in patients with primary hyperlipidemia, but niacin is best , HDL-C increase in the lipid drugs.11 Niacin inhibits the activity of hormone-sensitive lipase is responsible for the decrease in the sensitivity of lipolysis and thus decrease in secretion of VLDL hepatocytes.14 factors responsible for the decreased VLDL production are the inhibition of lipolysis with a decrease in free fatty acids in plasma, lower hepatic triglyceride esterification and a possible effect Live hepatic production of apolipoprotein B-. Niacin also increases HDL-C, reducing its catabolism. It reduces also increase levels of fibrinogen and tissue plasminogen activator. All these factors affect the process of atherogenesis and CHD.13-15 Recent studies also suggest that niacin also lowers blood pressure. possible mechanism is that niacin

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PATIENTS AND METHODS

This study at the Institute of Pharmacology and Therapeutics, Institute of Basic Medical Sciences, Jinnah Postgraduate Medical Centre, Karachi have been carried out from January to July 2002.Forty primary hyperlipidaemia selected patients originally included in the study for OPD Ward and the National Institute of Cardiovascular Disease, Karachi.Newly diagnosed and untreated patients with primary hyperlipidemia of the opposite sex, age 17-70 years were selected randomly. Patients with diabetes mellitus, peptic ulcer, kidney disease, liver disease, hypothyroidism, and alcoholism were from the study by laboratory tests are available, history and examination excluded. After explaining the limits of written consent was obtained from all study participants. The study consisted period of 90 days with biweekly visits. The necessary information such as name, age, sex, occupation, address, current medications, date of the follow-up visits and laboratory tests, etc. Each patient was recorded on a form designed specifically for this study. Initially a detailed medical history and physical examination of all patients were performed. All baseline evaluations were made on the day of admission (day 0) in the study and a similar assessment was made during the 90-day research design. After filling in the inclusion criteria patients were randomly divided into two groups, ieDrug-1 (tab: Niacin 2GM) and Drug-2 (placebo capsules, the same quantity of wheat milled in part) groups. The patients in Group 1 were invited Tab: niacin (250 mg), half a tablet three times daily after meals for two days, then increasing the dose of one tablet three times daily after meals for two days, then two tablets three times daily after without food for two days after which the dose of 3 tablets maintaibnace daily after meals three times a day until the end of the study period, IEEP day-90. This pattern of drug dose (so-called titration of niacin) was due to his avoidance of side effects produced by starting with higher doses of medication patients Niacin.17-2 group received placebo capsules used ieone capsule three times daily after meals for 90 days. The patients were to check every 2 weeks as a follow-up, blood pressure, weight, pulse, and general appearance of each. Compliance with the dosage of the drugs was followed by an interview and counseling at each clinic visit. Serum HDL-cholesterol was determined by the direct method, from day to day, 0-90, with the diagnostic kit # 303 210 040 Eli technology France.Data was expressed as mean + SD and “T” test used to statistical determine significance of differences. A probability value of <0.05 was the limit of significance.

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Results

of 40 patients, 37 completed the study period on the whole. Three patients discontinued the drug group (group niacin) due to side effects of drugs such as hot flashes, hot flushes, urinary and headache. were online database tables and figures show post-treatment results were even explainatory.When summaries and test parameters compared, we saw that after 90 days of treatment with niacin, HDL-cholesterol increased from 36.41 ± 1.96 mg / dl to 43 , 70 ± 1.81 mg / dl, the highly significant (P0.05) is. The percentage increase of the general attitude was 0.70.The difference between the means between the placebo and niacin 19.32 in Table No: 3.Mean systolic blood pressure of patients on niacin, reduced from 125.88 ± 3.48 mm Hg to 119.70 ± 3.13 mm Hg in three months, which is highly significant (P <0.001). Expressed in percentage terms, this reduction is 4.90%, as in Table 1 and placebo 3.In this reduction is shown, 1.62% (P <0.01) and the difference in the mean values of these two groups is 3.28. Niacin has been shown to reduce diastolic blood pressure in hyperlipidemia patients. He reduced the diastolic pressure on day 0, from 89.11 ± 1.92 mm Hg to 84.70 ± 1.74 mm Hg at day 90, the highly significant (P <0.001). Expressed in percentage terms, this reduction is 4.94%. Placebo group showed only a minor effect on diastolic pressure, or only 2.67%, but this difference was significant (P <0.01). Difference of mean values of diastolic pressure in 2groups is 2.27, as shown in Table 2, and 3

Table No: 1

changes in HDL-cholesterol, systolic and diastolic blood pressure in the group of patients, niacin (n = 17)

Parameter On day 0 at day-90% Change

HDL-C (mg / DL) 36.41 ± 1.96 43 70 ± 1.81 20.02

The systolic blood pressure 125.88 ± 3.48 119.70 ± 3.13 4.90

diastolic 89.11 ± 1.92 84.70 ± 1 74 4.94

Legend: ± standard error shows

numbers in parentheses indicate the number of patients

BP is in mm Hg

Table No: 2

Changes in HDL cholesterol measured , systolic and diastolic pressure in the placebo group of patients (n = 20)

Parameter On day 0 at day-90% change

HDL-C (mg / dl) 35.50 ± 1.13 35.75 ± 1.07 0.70

systolic 122.75 ± 2 120.75 ± 2.18 19 1.62

diastolic 84.25 ± 1.99 82.00 ± 1.82 2.67

key: ± shows standard error

figures in brackets are the number of patients BP in mm Hg

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user Table No: 3

Other than the development of HDL-cholesterol, systolic and diastolic blood pressure between the placebo and niacin groups of patients within 90 days of treatment.

placebo group (n = 20)

parameters reference Post Processing P-value

HDL-C 35.50 ± 1.13 35.75 ± 1.07 0.05

systolic 122.75 ± 120.75 2 19 ± 2.18 0.01

diastolic <84.25 ± 1.99 82.00 ± 1.82 0.01

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Post-Processing parameter reference value P% difference in the groups

HDL-C 36.41 ± 1.96 43.70 ± 1.81 19.32 0.001 Systolic 125.88 119.70 ± 3.48 3.28 ± 0.001

diastolic 89.11 ± 1.92 ± 1.74 0.001 84.70 2.27

Key: + indicates a standard

/ p 0.05> P-value

Key: Value p <0.01

P-value <0.001 indicates significant

numbers in parentheses indicate the number of patients

user discussion

Among the lipid-lowering agents, niacin appears to be the best HDL-raising agents. In our study, HDL-cholesterol level of 20% for men and women with a content of HDL-C level with an average dose of niacin (2 g / day) treated. The drug has a further advantage of being cheap. The levels of HDL-C, not only to increase by 20%, but kept going for three months with study therapy. This finding is consistent with the study by Martin et al4 Jadraque treatment with placebo capsules for 90 days, the HDL-cholesterol increased by 0.7% from the 3.7% increase in a research study lipids Clinics.18 7% increase in HDL-cholesterol was also in another study cited by Rivellese al.It and was been shown by Miller and AL5 that marathon runners do very high HDL-cholesterol subjects, that more sedentary. The increase in HDL-cholesterol through exercise training may be a consequence of increased degradation of triglyceride-lipoproteins (VLDL). It has been observed by McKinney and AL7 that high doses of niacin crystal increases of 30% of the concentration of HDL-C. This observation is contrary to our observation, it was probably used because of the small sample size at low doses of niacin 6gm drug.They in 80 patients for the four months.Drop rates in our study, 15% and most patients discontinued treatment because of the development of side effects such as flushing, urticaria and feeling hot in the body. Other patients have been convinced of continuous therapy, with a system of concentration camps dose (titration) of niacin or aspirin 250 mg OD, before taking the first dose of the drug in the morning. Wilkin et al have induced the mechanism of aspirin niacin blocks down flushing.8 Stern et al, that tolerance to flushing, urticaria, and sharpness in the body develops, as described by titration of the dose of niacin. Niacin produces prostaglandin D-3, which causes vasodilatat and lowers blood pressure. is

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According to the published results of this study and data from the literature, it is concluded that niacin reduced the risk of coronary disease increased HDL- C and a reduction in blood pressure, it might be advisable that the drug can be used as monotherapy in patients with hyperlipidemia, are low in the HDL-C and are likely to develop atherosclerosis. ‘/ P>

REFERENCES ‘ / strong>

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