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Use of Niacin During Non–ST-Segment Elevation Acute Coronary Syndromes—Reply
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In Reply: Dr Goldstein raises concern over the use of nicotinic acid (niacin) in the acute management of patients with non–ST-segment elevation acute coronary syndromes. This is based on a case report from 1991 that describes worsened ischemia in 2 patients with unstable angina following the administration of crystalline niacin.1 We are aware of no other similar reports.
While niacin has well-known vasodilating properties,2 its specific effect on the coronary vasculature is not well described. Because niacin causes flushing, it has been suggested that it acts preferentially on small resistance vessels.2 This has led to speculation that niacin may be detrimental in myocardial ischemia because it may produce systemic hypotension and coronary artery hypoperfusion and may selectively dilate coronary vessels in areas of collateral-dependent myocardium, resulting in coronary artery steal.1
Since 1991, the treatment of patients with coronary artery disease has changed considerably. Extended-release niacin is used preferentially over crystalline . . . [Full Text of this Article]
Ty J. Gluckman, MD;
Molly Sachdev, MD;
Steven P. Schulman, MD
Division of Cardiology
Johns Hopkins Hospital
Roger S. Blumenthal, MD
rblument@jhmi.edu
Ciccarone Preventive Cardiology Center
Johns Hopkins University
Baltimore, Md
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