Nicotinic acid and other therapies for raising high-density lipoprotein.
OBJECTIVE
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.


RESULTS
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.


CONCLUSIONS
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.
Carlson
Lars A
LA
Karolinska Institutet, King Gustaf V Research Institute, Stockholm, Sweden. lars.a.carlson@bredband.net
D050197:Atherosclerosis / Q000097:blood / Q000188:drug therapy / Q000517:prevention & control; D004359:Drug Therapy, Combination; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000494:pharmacology*; D000960:Hypolipidemic Agents / Q000494:pharmacology*; D008019:Life Style; D008075:Lipoproteins, HDL / Q000097:blood* / Q000187:drug effects*; D008077:Lipoproteins, LDL / Q000097:blood / Q000187:drug effects; D009525:Niacin / Q000494:pharmacology*; D012307:Risk Factors; D016896:Treatment Outcome
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000960:Hypolipidemic Agents; D008075:Lipoproteins, HDL; D008077:Lipoproteins, LDL; D009525:Niacin