Nicotinic acid in the treatment of hyperlipidaemia

Nicotinic acid has been in use as a lipid-lowering drug for five decades now. It is effective in lowering low-density lipoprotein (LDL)-cholesterol, triglycerides, and lipoprotein (a), and in increasing high-density lipoprotein (HDL)-cholesterol. All these effects are pronounced, and at present greater increase of HDL-cholesterol cannot be obtained by any other drug. Patients with hypertriglyceridaemia/low HDL-cholesterol are the most suitable candidates for being treated with this drug. This pattern is typical for type 2 diabetic patients, for patients with metabolic syndrome, and for those with impaired glucose tolerance. From a few studies, there is evidence that nicotinic acid is effective in reducing cardiovascular events. Although overall safety is good, the unpleasant side effect of flushing, albeit not harmful, precludes many patients from taking the drug. New formulations of intermediate release or a combination with anti-flush compounds should increase the compliance with the drug.