Efficacy, safety, and tolerability of once-daily niacin for the treatment of dyslipidemia associated with type 2 diabetes: results of the assessment of diabetes control and evaluation of the efficacy of niaspan trial.

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Abstract
ALTERATIONS IN lipid metabolism are recognized concomitant symptoms of diabetes mellitus. It is believed that even before the development of overt diabetes, insulin resistance and a prediabetic state impair the mechanism that suppresses fatty acid release from adipose tissue after food intake.1 The resultant excess of free fatty acids leads to increased concentrations of triglyceride (TG)–rich particles (very low-density lipoproteins and chylomicrons) and TG enrichment of high- and low-density lipoprotein (HDL and LDL), affecting virtually every lipid and lipoprotein variable.2 The end result is a dyslipidemia that is characterized by elevated TG levels, the generation of small, dense LDL particles, and reduced HDL cholesterol (HDL-C) concentrations. This combination of features is known by many designations, including atherogenic dyslipidemia, dyslipidemia of insulin resistance, or the atherogenic lipoprotein phenotype. It contributes to the 2- to 4-fold excess risk for cardiovascular disease observed in patients with type 2 diabetes mellitus compared with nondiabetic individuals.3 It is also increasingly recognized that the presence of diabetes places most patients at the same near-term risk for a coronary event as that of a patient with existing coronary heart disease (CHD). In this respect, diabetes is now considered to be a CHD risk equivalent by the National Cholesterol Education Program Adult Treatment Panel III4 and the American Heart Association.5 At present, most patients with diabetes die of CHD.