Nicotinic Acid and New-Onset Diabetes

Dear Editors,

Blond et al. [1], in their elegant study, showed that extended-release nicotinic acid, beneficially affected the lipid profile of 20 nondiabetic dyslipidemic men with metabolic syndrome (MetS), but induced liver insulin resistance.

Nonalcoholic fatty liver disease (NAFLD), the hepatic manifestation of MetS, is associated with an increased risk for cardiovascular disease (CVD). Statins may reduce this CVD risk and also improve liver tests associated with NAFLD [2] [3]. It would be useful to know if nicotinic acid influenced insulin resistance differentially in patients with higher hepatic enzyme activities in the Blond et al. study [1]. Furthermore, accumulation of diacylglycerol in hepatocytes [1] has been implicated in NAFLD-related liver insulin resistance [4].

Hyperuricemia may occur following nicotinic acid treatment [5]. Did Blond et al. [1] assess serum uric acid (SUA) levels? Raised SUA levels are also associated with NAFLD [6].

Statins increase the risk of new-onset diabetes (NOD) [7] [8]. Similarly, nicotinic acid has been associated with an increased risk of impaired fasting glucose and NOD whether administered as monotherapy or in combination with a statin [9] [10]. It is likely that the statin+nicotinic acid combination increases the risk of NOD. In the HPS2-THRIVE study [11], NOD was more frequent in the statin+nicotinic acid group compared with the statin+placebo group (3 vs. 0 cases in the run-in period and 13 vs. 5 cases during follow-up; p not reported). Similarly, the incidence of elevated liver tests was almost doubled in the statin+nicotinic acid group compared with the statin+placebo group [i. e., alanine aminotransferase (ALT) 3×upper limit normal (ULN) 0.30 vs. 0.14% per year during follow-up; p<0.001], especially in Chinese patients [11]. Gout prevalence was also higher in the statin+nicotinic acid group compared with the statin+placebo group (60 vs. 5 cases in the run-in period and 26 vs. 8 cases during follow-up; p not reported).

• References

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