Because of the adverse side effects associated with high doses of niacin (see Safety ), it has most often been used in combination with other lipid-lowering medications in slightly lower doses (54) . In particular, LDL cholesterol-lowering statins like simvastatin form the cornerstone of treatment of hyperlipidemia , a major risk factor for CHD. The HDL- Atherosclerosis Treatment Study (HATS), a three-year randomized controlled trial in 160 patients with documented CHD and low HDL levels found that a combination of simvastatin and niacin (2 to 3 grams/day) increased HDL levels, inhibited the progression of coronary artery stenosis (narrowing), and decreased the frequency of cardiovascular events, including myocardial infarction and stroke (58) . Patients with metabolic syndrome display a number of metabolic disorders, including dyslipidemia and insulin resistance , that put them at increased risk for type 2 diabetes mellitus , cardiovascular disease, and mortality. A subgroup analysis of the HATS patients with metabolic syndrome showed a reduction in rate of primary clinical events even though glucose and insulin metabolism were moderately impaired by niacin (59) . Moreover, a review of niacin safety and tolerability among the HATS subjects showed glycemic control in diabetic patients returned to pretreatment values following eight months of disease management with medication and diet (60) . Similarly, the cardiovascular benefit of long-term niacin therapy outweighed the modest increase in risk of newly onset type 2 diabetes in patients from the CDP study (61) .
Cushing's syndrome is the result of excessive corticosteroids in the body. The main cause is overproduction of adrenocorticotropin hormone (ACTH) in the pituitary gland. ACTH causes the adrenal glands to produce corticosteroids, so too much of ACTH means too much of corticosteroids. Another main cause is taking long-term external steroids like prednisone (sometimes used in some chronic diseases). In addition, certain lung cancers and other tumors outside the pituitary gland may produce corticotropins. Other causes include benign or cancerous tumors on the adrenal glands. Rarely, Cushing syndrome can be an inherited endocrine disorder.
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