Niacin revisited: clinical observations on an important but underutilized drug
Article Abstract:
Several factors that increase the risk of developing heart disease have been identified. The vitamin niacin can lower the risk by altering blood lipid (fat) levels. It can lead to decreases in several cholesterol-transporting particles, including very-low-density lipoprotein cholesterol (VLDL-C) and low-density lipoprotein cholesterol (LDL-C), while beneficially raising high-density lipoprotein cholesterol (HDL-C). Probably because of these effects, niacin can reverse formation of fatty plaques on arterial walls and reduces mortality from heart disease. It is also safe with long-term use and has a low cost, all of which should make it a drug of choice. However, it is not popular, due to its ubiquitous side effect of causing flushing or itching of the skin, and patients may tend not to use it. Gradual increases in dosage and use of slow-release (SR) preparations may decrease this problem, and education about the expected side effects enhances patient compliance. Infrequently, more severe side effects such as gastrointestinal disorders and liver disease may occur, usually at high doses or possibly with SR preparations. The experience gained in niacin treatment of 82 patients with high blood lipid levels (including 17 patients with heart transplants, HTR) was evaluated from medical records, and pharmacists' recommendations about niacin use were studied. Decreases in total cholesterol, LDL-C, and VLDL-C and increases in HDL-C were similar in HTR and nontransplant (NTP) groups. In the NTP group, those with higher initial VLDL-C levels had greater reductions in VLDL-C and smaller decreases in LDL-C. Significantly more HTR patients, many with pre-treatment diabetes, discontinued niacin, chiefly because of uncontrolled hyperglycemia (high blood sugar). Diabetic NTP patients did not have problems with blood sugar control related to niacin treatment. Seven patients (half of those treated with SR-niacin) developed hepatitis. Use of an unknown preparation and one from a health food store led to two other cases of hepatitis. SR-niacin, but not regular preparations, were readily available and recommended by pharmacists, some of whom were unaware of the possibility of hepatitis. Niacin used with lovastatin, another cholesterol-lowering drug, was particularly effective in lowering cholesterol. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1991
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Mycobacterium fortuitum presenting as an asymptomatic enlarging pulmonary nodule
Article Abstract:
The most well known infections caused by mycobacteria are tuberculosis and leprosy. In lung tissue, these infections often exude fluid containing cells, resembling bacterial pneumonia. These pulmonary infections most often occur in white middle-aged males who have chronic pulmonary disease. Mycobacterium fortuitum (M. fortuitum) may cause only surface lesions and tends to be opportunistic, that is, to develop in the presence of immune system deficiency. A case is described of a 65-year-old woman who developed an unusual type of pulmonary M. fortuitum infection. In her case underlying lung disease was absent and her immune system was not deficient. Other risk factors, such as a history of aspiration of substances into the lungs, presence of diabetes, or unusual travel history, were also absent. The infected lesion was abnormal as well, being confined to a noncalcified nodule in the right upper lobe of the lung without having disseminated to other sites in the body. The patient had a nonproductive cough that contained no blood. During workup for diagnosis, tests for tuberculosis were negative, and material removed from the lesion by needle aspiration was negative. She was treated with medications usually given for tuberculosis because this was suspected, but she discontinued these due to indigestion. On readmission to the hospital for depression, the lesion was found to be enlarged. The lesion was removed during surgery and the mycobacterium was then identified. No antibiotic therapy was given, and the patient was well eight months later, without recurrence. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1991
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