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July 25, 1994

Nicotinic Acid as a Lipoprotein-Altering Agent: Therapy Directed by the Primary Physician

Author Affiliations

Fred Hutchinson Cancer Research Center Women's Health Initiative Coordinating Center 1124 Columbia St MP 1002 Seattle, WA 98104-6883; Minneapolis, Minn

Arch Intern Med. 1994;154(14):1557-1559. doi:10.1001/archinte.1994.00420140015002

CARDIOVASCULAR DISEASES (CVD) and, in particular, coronary heart disease (CHD) remain the leading cause of death and disability in the western world.1 Elevated plasma low-density lipoprotein cholesterol (LDL-C) and reduced high-density lipoprotein cholesterol (HDL-C) levels are among the most important risk factors for these diseases.2 Hydroxymethylglutaryl coenzyme A reductase inhibitors (HMG-CoA-RI), bile acid sequestrants, and nicotinic acid are the major classes of drugs identified for the reduction of elevated total and LDL-C levels in the Adult Treatment Panel II Report.3 Although highly effective, two of these (bile acid sequestrants and nicotinic acid) have substantial side effects and two (bile acid sequestrants and HMG-CoA-RI) have substantial cost. Nicotinic acid has the greatest HDL-raising effect of any agent used to date4; lesser effects have been observed with gemfibrozil5 and HMG-CoA-RI.6 Independent benefit on CVD or CHD risk by increasing plasma levels of HDL has not been

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