To the Editor.—In their excellent discussion of the role of high-density lipoprotein in the management of hypercholesterolemia, Grundy et al1 take note of the fact that nicotinic acid is a first-line drug for the treatment of an elevated low-density lipoprotein—cholesterol (if diet alone has been insufficient) and, in addition, that it has the capacity to raise high-density lipoprotein.
Unfortunately, many physicians are of the opinion that nicotinic acid is a poorly tolerated drug. However, if one reviews the extensive experience of the Coronary Drug Project one finds that this agent is well tolerated by a majority of patients over long periods of time.
In the latter study2 the mean percent adherence (after sub[ill]racting both dropouts and nonadherers) to a prescription of 3 g of niacin daily was reported to be 66.3% for the initial 5 years of follow-up. Hence, nicotinic acid's overall patient acceptability record is good.
HUTCHINSON RG. Nicotinic Acid and Hypercholesterolemia. Arch Intern Med. 1990;150(7):1548. doi:10.1001/archinte.1990.00390190178036