Nicotinic acid has been shown to have beneficial effects on blood lipid levels. In this regard nicotinic acid can normalise raised levels of blood lipids and reduce cardiovascular disease risk, when taken at pharmacological levels above its normal vitamin requirement. Evidence suggests that nicotinic acid is able to have favourable effects on lipids because it directly and noncompetitively inhibits hepatocyte diacylglycerol acyltransferase–2. As this enzyme is required for triglyceride synthesis, its inhibition reduces the synthesis of triglycerides and reduces very low density lipoprotein (VLDL) particles. As the VLDL particle is made of triglycerides and responsible for transporting them to the blood, this also reduces blood lipid levels. At the same time, intracellular apolipoprotein (apo) B containing lipoproteins (i.e. the VLDL particle) continue to be degraded. Further, as the low density lipoprotein particle is derived from the VLDL particle, this process also lowers levels of LDL. In addition, nicotinic acid also reduced catabolism of apolipoprotein (apo) A-I containing lipoproteins, which in effect is the high density lipoprotein (HDL) particle. This raises levels of HDL in the blood by increasing its halflife,and the raised levels of HDL are associated with a reduced risk of cardiovascular disease. In addition, niacin may also reduce levels of oxidative stress in the blood by improving the reductive capacity of vascular endothelial cells. Further niacin may also reduce the expression of inflammatory genes that give rise to inflammatory cytokines that are required for the development of inflammation in the arteries.
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