Extended-release niacin acutely suppresses postprandial triglyceridemia

Am J Med. 2012 Oct;125(10):1026-35. doi: 10.1016/j.amjmed.2012.03.017. Epub 2012 Jul 25.


Objective: Postprandial triglyceridemia predicts cardiovascular events. Niacin might lower postprandial triglycerides by restricting free fatty acids. Immediate-release niacin reduced postprandial triglycerides, but extended-release niacin failed to do so when dosed the night before a fat challenge. The study aims were to determine whether extended-release niacin dosed before a fat challenge suppresses postprandial triglycerides and whether postprandial triglycerides are related to free fatty acid restriction.

Methods: A double-blinded, placebo-controlled, random-order crossover experiment was performed, in which healthy volunteers took 2 g extended-release niacin or placebo 1 hour before heavy cream. We sampled blood over 12 hours and report triglycerides and free fatty acid as means ± standard deviation for incremental area under the curve (AUC) and nadir.

Results: By combining 43 fat challenges from 22 subjects, postprandial triglycerides incremental AUC was +312 ± 200 mg/dL*h on placebo versus +199 ± 200 mg/dL*h on extended-release niacin (33% decrease, P=.02). The incremental nadir for free fatty acid was -0.07 ± 0.15 mmol/L on placebo versus -0.27 ± 0.13 mmol/L on extended-release niacin (P<.0001), and free fatty acid incremental AUC decreased from +2.9 ± 1.5 mmol/L*h to +1.5 ± 1.5 mmol/L*h on extended-release niacin (20% decrease, P=.0015). The incremental AUC for triglycerides was strongly related to the post-dose decrease in free fatty acid (r = +0.58, P=.0007).

Conclusions: Given right before a fat meal, even a single dose of extended-release niacin suppresses postprandial triglyceridemia. This establishes that postprandial triglycerides suppression is an acute pharmacodynamic effect of extended-release niacin, probably the result of marked free fatty acid restriction. Further study is warranted to determine whether mealtime dosing would augment the clinical efficacy of extended-release niacin therapy.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Biomarkers / blood
  • Black or African American
  • Cross-Over Studies
  • Delayed-Action Preparations
  • Double-Blind Method
  • Fatty Acids, Nonesterified / blood
  • Humans
  • Hypertriglyceridemia / blood
  • Hypertriglyceridemia / ethnology
  • Hypertriglyceridemia / prevention & control*
  • Hypolipidemic Agents / therapeutic use*
  • Niacin / therapeutic use*
  • Postprandial Period*
  • ROC Curve
  • Regression Analysis
  • Treatment Outcome
  • Triglycerides / blood


  • Biomarkers
  • Delayed-Action Preparations
  • Fatty Acids, Nonesterified
  • Hypolipidemic Agents
  • Triglycerides
  • Niacin