Which medication is best to raise HDL?

Which medication is best to raise HDL?

• A. Niacin
• B. Fibrates
• C. Statins
• D. Cholestyramine

Answer: (A)

Niacin raises HDL the most among common lipid-lowering medications. It works by multiple mechanisms that slow HDL breakdown and boost HDL production: it inhibits adipose tissue lipolysis, reducing free fatty acids delivered to the liver and lowering hepatic VLDL synthesis, and it also decreases hepatic clearance of HDL particles, particularly the larger HDL2 fraction. The net result is a substantial rise in HDL cholesterol, typically more than with other agents. In contrast, fibrates mainly lower triglycerides and only modestly raise HDL; statins produce small HDL increases; bile acid sequestrants and cholesterol absorption inhibitors generally don’t raise HDL and can even lower it slightly. Therefore, niacin is the best choice for increasing HDL, though its use is limited by side effects like flushing, glucose intolerance, and gout.

Niacin raises HDL the most among common lipid-lowering medications. It works by multiple mechanisms that slow HDL breakdown and boost HDL production: it inhibits adipose tissue lipolysis, reducing free fatty acids delivered to the liver and lowering hepatic VLDL synthesis, and it also decreases hepatic clearance of HDL particles, particularly the larger HDL2 fraction. The net result is a substantial rise in HDL cholesterol, typically more than with other agents.

In contrast, fibrates mainly lower triglycerides and only modestly raise HDL; statins produce small HDL increases; bile acid sequestrants and cholesterol absorption inhibitors generally don’t raise HDL and can even lower it slightly. Therefore, niacin is the best choice for increasing HDL, though its use is limited by side effects like flushing, glucose intolerance, and gout.