Nicotinic Acid for the Treatment of Hyperlipoproteinemia

Nicotinic acid is a water‐soluble B‐complex vitamin that has been shown, in high doses, to lower total plasma cholesterol (C), LDL‐C, and VLDL‐triglycerides (Tg), while raising HDL‐C in patients with type II, III, IV, and V hyperlipoproteinemia. Its exact mechanism of action is not known, but it appears to lower the production of VLDL in the liver while activating lipoprotein lipase. The drug may also influence the metabolism of HDL‐C. The drug is a second or third choice for isolated hypercholesterolemia because of a high incidence of side effects. However, it has a therapeutic advantage as a monotherapy when reduction of both LDL‐C and triglycerides are needed in patients with severe combined hyperlipidemia. The drug can be used in combination with other cholesterol‐lowering agents to maximize lipid‐lowering activity. Nicotinic acid has been associated with a reduced risk of cardiovascular morbidity in clinical trials.