Nicotinic acid and other therapies for raising high-density lipoprotein

• Published in: Current opinion in cardiology Vol. 21; no. 4; p. 336
• Main Author: Carlson, Lars A
• Format: Journal Article
• Language: English
• Published: United States 01.07.2006
• Subjects: Atherosclerosis - blood; Atherosclerosis - drug therapy; Atherosclerosis - prevention & control; Drug Therapy, Combination; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - pharmacology; Hypolipidemic Agents - pharmacology; Life Style; Lipoproteins, HDL - blood; Lipoproteins, HDL - drug effects; Lipoproteins, LDL - blood; Lipoproteins, LDL - drug effects; Niacin - pharmacology; Risk Factors; Treatment Outcome
• ISSN: 0268-4705
• DOI: 10.1097/01.hco.0000231404.76930.e9

The purpose of this review is to describe the high-density-lipoprotein-raising effect of nicotinic acid and the clinical effects of treatment on cardiovascular diseases, particularly in combination with statins. Other treatments for raising high-density lipoprotein, including changes in lifestyle, other drugs and infusions of 'synthetic' (reconstituted) high-density lipoprotein will be summarized. Treatment of atherosclerotic cardiovascular disease with nicotinic acid and statin results in a pronounced increase of protective high-density lipoprotein cholesterol and reduces morbidity/mortality. Addition of prolonged-release nicotinic acid to ongoing treatment with statin raises high-density lipoprotein cholesterol and induces regression of atherosclerosis that otherwise would progress during statin treatment. Several new high-density lipoprotein-raising drugs in clinical trials are reported. New proposed mechanisms for the broad-spectrum lipid effects of nicotinic acid are described. Low plasma concentration of high-density lipoprotein is an important risk factor for atherosclerotic cardiovascular disease. Nicotinic acid has the uncomfortable but harmless side effect of flush. Prolonged-release nicotinic acid gives rise to less flush than immediate-release nicotinic acid. Treatment with nicotinic acid and statin targets the two independent lipid risk factors of low high-density lipoprotein and high low-density lipoprotein and has clinical benefits in secondary prevention of atherosclerotic cardiovascular disease.