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May 4, 2005

Use of Niacin During Non–ST-Segment Elevation Acute Coronary Syndromes

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2005;293(17):2092-2093. doi:10.1001/jama.293.17.2092-c

To the Editor: The Clinical Review by Dr Gluckman and colleagues1 on the management of non–ST-segment elevation acute coronary syndromes suggests considering the addition of niacin to statins if high-density lipoprotein cholesterol levels are less than 40 mg/dL (1.0 mmol/L) or triglyceride levels are greater than 150 mg/dL (1.7 mmol/L). However, niacin can be dangerous and might even increase myocardial ischemia in the acute setting.2 This may occur on the basis of coronary steal and/or lowering coronary perfusion pressure due to the vasodilating properties of niacin.

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