Increasing HDL Cholesterol

Low levels of high-density-lipoprotein (HDL) or "good cholesterol" contribute to cardiovascular risk. Every 10% decrease in HDL may increase  cardio-vascular risk by 13%. Niacin raises HDL more than any other agent, effectively lowers low-density-lipoprotein (LDL) by 5% to 25% and triglycerides by 20% to 50%, and reduces the incidence of nonfatal heart attacks and death. However, immediate release niacin should be taken 2 to 3 times a day and may cause significant flushing. This side effect can be minimized by starting slowly (e.g., 50 to 100 mg two to three times daily for the first week, titrating up to usual dose of immediate-release niacin which is 1,500 mg to 3,000 mg daily), taking aspirin 30 minutes before niacin, and taking with meals. Long-acting niacin products (sustained-release, timed-release, or controlled-release) cause less flushing but are associated with liver toxicity. Inositol hexaniacinate ("no-flush" niacin) probably doesn't work as well as regular niacin to raise HDL. Niacin should be avoided in patients with chronic liver disease, severe gout, active peptic ulcer disease, and arterial bleeding, and used cautiously in patients with hyperuricemia and diabetes.