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Niacin Found Most Effective in Raising HDL Cholesterol

High HDL-C linked to lower heart disease risk; new treatments targeting HDL-C hold promise

THURSDAY, April 1 (HealthDay News) -- Lifestyle changes modestly increase high-density lipoprotein cholesterol (HDL-C) levels, but the most effective treatments are niacin derivatives, although newer treatments being examined are promising, according to a review in the March 30 issue of the Journal of the American College of Cardiology.

Noting that overwhelming evidence has shown that high levels of HDL-C are associated with a lower risk of coronary heart disease, Pradeep Natarajan, M.D., from Harvard Medical School in Boston, and colleagues reviewed how HDL-C protects against coronary heart disease and how these biological pathways are targeted by therapeutics.

The researchers note that reverse cholesterol transport is one of the primary anti-atherogenic properties of HDL-C, but the mechanisms controlling HDL-C are more complex than those controlling low-density lipoprotein cholesterol. Lifestyle interventions such as exercise, diet control, weight loss, smoking cessation, and moderate alcohol intake modestly increase HDL-C levels. The best medications are currently the niacin (vitamin B3) derivatives, although newer drugs such as apolipoprotein mimetics are also promising, per the report.

"The next five years should provide information on whether the flux or cycling of HDL is more important than HDL-C levels and also whether we should target raising specific HDL subclasses rather than HDL-C itself," Natarajan and colleagues conclude.

All three authors reported advisory and financial relationships with pharmaceutical companies.

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