Nicotinic acid and other therapies for raising high-density lipoprotein

PURPOSE OF REVIEW: 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. RECENT FINDINGS: 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. SUMMARY: 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.