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BMJ Case Rep. 2010; 2010: bcr06.2009.2028.
Published online Jan 13, 2010. doi:  10.1136/bcr.06.2009.2028
PMCID: PMC3030282
Learning from errors
A patient’s informative mistake: niacin is very effective in correcting dyslipidaemia
Michelle Fung1 and Jiri Frohlich2
1University of British Columbia, Medicine, 4117-2775 Laurel Street, Vancouver, British Columbia, V5Z1M9, Canada
2University of British Columbia, Pathology, St Paul’s Hospital Healthy Heart Program, Vancouver, British Columbia, V6Z 1Y6, Canada
Jiri Frohlich, jifr/at/unixg.ubc.ca
Abstract
A 72-year-old man at high risk for cardiovascular disease, with a history of peripheral vascular disease and type 2 diabetes, presented with lipids above targets despite maximum daily treatment with atorvastatin 80 mg, fenofibrate supra 160 mg daily, and ezetimibe 10 mg. His low density lipoprotein cholesterol (LDL-C) was 2.6 mmol/l, total cholesterol: HDL ratio 5.6, and high density lipoprotein cholesterol (HDL-C) 0.9 mmol/l. Because his lipids were not within target, he was advised to start 2250 mg of niacin in three divided doses daily. For 5 months, he mistakenly took 2250 mg of niacin three times daily, a consumption of 6750 mg/day! The effects on his lipids were: HDL-C increased nearly 100% to 1.7 mmol/l, LDL-C decreased by 50% to 1.3 mmol/l, and cholesterol: HDL ratio decreased by over 50% to 2.1. His excessive intake dramatically demonstrates the positive effect of niacin on lipids. Fortunately he did not suffer adverse effects from taking more than the recommended limit of 3000 mg/day.
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