Letters Section Editor: Robert M. Golub,
MD, Senior Editor.
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.
Goldstein MR. Use of Niacin During Non–ST-Segment Elevation Acute Coronary Syndromes. JAMA. 2005;293(17):2092-2093. doi:10.1001/jama.293.17.2092-c