UNSTABLE MYOCARDIAL-ISCHEMIA AFTER THE INITIATION OF NIACIN THERAPY

Niacin has been used as a pharmacologic agent for the treatment of hypercholesterolemia for >3 decades.1-3 Current interest in niacin therapy has been reawakened, in part as a result of its status as a "first-line" drug in the treatment of hyperlipidemia according to the National Cholesterol Education Program guidelines.4 Unfortunately, adverse effects limiting its use are frequent. These include gastrointestinal problems, flushing, atrial arrhythmias, abnormalities of liver function, hyperglycemia and hyperuricemia. We encountered an apparently unrecognized adverse effect of niacin that may be of great clinical importance in patients with active ischemic heart disease-namely, worsening of unstable ischemia, perhaps on the basis of coronary steal. © 1991.