Effects of Nicotinic Acid Therapy on Plasma Lipoproteins and Very Low Density Lipoprotein Apoprotein C Subspecies in Hyperlipoproteinemia

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Abstract
The effects of long term treatment with nicotinic acid on lipids, lipoproteins, and the plasma distribution of very low density lipoproteins (VLDL) apoprotein C (ApoC) subspecies were studied in 33 patients with types IIa (n = 9), lib (n = 11), and IV (n = 13) hyperlipidemias. After 6 months of treatment, a significant decrease in triglyceride, total cholesterol, and low density lipoprotein (LDL) cholesterol levels occurred. High density lipoprotein (HDL) cholesterol increased significantly by 31.1%, 41.8%, and 32.0% in types Ila, lib, and IV, respectively (P < 0.01 for all). A significant negative correlation existed between changes in HDL cholesterol and triglycerides (r = –0.613; P < 0.02) in all groups studied. Therapy also produced changes in VLDL, LDL, and HDL protein concentrations. VLDL protein decreased from 20.9 ± 3.9 to 15.2 ± 1.0 mg/dl (P < 0.05) in type Ila. In types lib and IV, mean VLDL protein decreased from 44.7 ± 8.2 to 27.1 ± 3.9 mg/dl (P < 0.001) and from 46.3 ± 7.1 to 30.6 ± 4.9 mg/dl (P < 0.001), respectively. LDL protein decreased significantly, and HDL protein increased in type Ila only. Gel isoelectric focusing of VLDL before and after nicotinic acid in types lib and IV hyperlipidemia produced a significant increase in the VLDL ApoC-II component with simultaneous decreases in the total VLDL ApoC-III subspecies. This resulted in increases in the ApoC-II to ApoC-III area ratio from 0.50 ± 0.1 to 1.02 ± 0.2 (P < 0.001) in type lib and from 0.62 ± 0.07 to 0.88 ± 0.13 (P < 0.01) in type IV, respectively. The ApoE subspecies and the ApoE-III to ApoE-II area ratio did not change significantly. Our results show that nicotinic acid produces a significant improvement in the lipoprotein profiles of these patients. (J Clin Endocrinol Metab54: 1210, 1982)