Niacin in the prevention of atherosclerosis: Significance of vasodilatation

SummaryThere is a rising interest towards the old drug, nicotinic acid (niacin, vitamin B3), because at pharmacological concentrations it has a beneficial effect on HDL cholesterol. Its use, however, was limited due to its adverse effect, flushing. When the mechanism of flushing was solved, a combination of niacin and DP1 receptor antagonist or prostaglandin inhibitor is used, there has been a comeback of niacin with extensive clinical trials. This paper argues that the new strategy with niacin for the prevention of atherosclerosis should be re-evaluated, because vasodilatation of the peripheral vessels might be crucially important in the early primary prevention according to our “vasa vasorum hypoxia” hypothesis.