EFFECT OF NICERITROL ON FIBRINOLYSIS AND LIPOPROTEIN (A) LEVELS IN PATIENTS WITH CORONARY-ARTERY DISEASE

Background Lipoprotein (a) [Lp(a)] is an independent risk factor for c oronary artery disease and niceritrol (a prodrug of nicotinic acid) is known to reduce Lp(a) levels, Patients with coronary artery disease o ften have impairment of the fibrinolytic system. Methods To elucidate the effect of niceritrol on fibrinolysis and Lp(a) levels, we examined plasminogen activator inhibitor (PAI) activity, tissue-type plasminog en activator (t-PA) antigen, and serum Lp(a) levels before and after a dministration of niceritrol to coronary artery disease patients with h igh baseline Lp(a) levels (greater than or equal to 20 mg/dl). Nicerit rol was administered to 26 patients for 12 weeks at 750 mg/day. Fastin g blood samples were obtained at 0800 h from each patient before treat ment, after administration of niceritrol for 12 weeks and 4 weeks afte r the discontinuation of therapy. Results There were significant reduc tions in PAI activity (9.9 +/- 1.8 compared with 5.4 +/- 1.6 IU/ml, P < 0.01), t-PA antigen levels (10.0 +/- 0.5 compared with 8.8 +/- 0.6 n g/ml, P < 0.05), and Lp(a) levels (49.3 +/- 5.9 compared with 42.5 +/- 5.4 mg/dl, P < 0.01) after 12 weeks of niceritrol administration. Fou r weeks after the discontinuation of niceritrol treatment, all these p arameters returned to baseline. Conclusions This study demonstrated th at niceritrol administration decreases PAI activity and t-PA antigen l evels together with Lp(a) levels in patients with coronary artery dise ase. These observations suggest that niceritrol administration may ten d to normalize fibrinolysis in such patients.