Niaspan®: creating a new concept for raising HDL-cholesterol

Low high-density lipoprotein (HDL)-cholesterol is associated with increased cardiovascular risk and often persists despite treatment with a statin. Nicotinic acid is the most effective agent available for correcting low HDL-cholesterol, but tolerability concerns have limited its use in the past. Niaspan w is a new, once-daily, prolonged-release formulation of nicotinic acid, which provides equivalent efficacy on the lipid profile to the immediate-release formulation. Treatment with Niaspan, alone or combined with a statin, is associated with marked improvements on HDL-cholesterol. Useful additional reductions in triglycerides and low density lipoprotein-cholesterol also occur when Niaspan is added to statin therapy. Analysis of lipid subprofiles shows that Niaspan treatment induces a shift from small, dense, highly atherogenic lipoproteins to a less atherogenic lipid profile, which is characterized by larger, more buoyant lipoprotein particles. The tolerability profile of Niaspan is superior to that of immediate-release nicotinic acid, with a significantly reduced frequency of flushing, and an incidence of hepatotoxicity or muscle side-effects similar to that of a statin. This beneficial therapeutic profile is also observed among patients with type 2 diabetes or the metabolic syndrome, with minimal impact on glycaemic control. Niaspan provides a practical new approach to the correction of low HDL-cholesterol in everyday clinical practice.