Role of nicotinic acid in raising high-density lipoprotein cholesterol (HDL-C) to reduce cardiovascular risk: An Asian/Pacific consensus

Cardiovascular disease is a leading cause of morbidity and mortality in Asia, and the burden of disease is expected to rise further in the 21st century. As in Western populations, dyslipidaemia is an important cardiovascular risk factor in Asian people. International guidelines focus on reduction of low-density lipoprotein cholesterol (LDL-C) for prevention and treatment of coronary heart disease (CHD). However, increasing body mass index and prevalence of type 2 diabetes and metabolic syndrome in Asia have highlighted the importance of low levels of high-density lipoprotein cholesterol (HDL-C) as a coronary risk factor. Therapeutic lifestyle changes and pharmacological intervention aimed at raising HDL-C, should benefit such patients. Weight loss and physical exercise are important interventions for raising HDL-C. However, to achieve target HDL-C levels pharmacological intervention is usually necessary. Current treatment options include statins, fibrates and nicotinic acid, either as monotherapy or in combination. Statins are generally regarded as the foundation of lipid-modifying therapy. Mainly via reduction of LDL-C. Both fibrates and nicotinic acid are effective in raising HDL-C levels, and reducing triglyceride-rich lipoproteins. The efficacy and safety profile of nicotinic acid demonstrated in Western populations indicates the clinical benefits of this therapy either alone or in combination with a statin. Based on the available evidence, the Pan-Asian Consensus Panel recommends that HDL-C levels should be raised to at least 1.0 mmol/L (40 mg/dL) in Asian patients with CHD or with a high level of risk for premature vascular disease, including patients at high risk with type 2 diabetes or the metabolic syndrome.