Which statement about lipid-lowering therapy is true?

Which statement about lipid-lowering therapy is true?

• A. Bile acid sequestrants are the only safe option in pregnancy
• B. Statins are first-line for lowering triglycerides
• C. Niacin is the best agent to raise HDL
• D. Fibrates are the best agents to lower LDL

Answer: (C)

Raising HDL cholesterol is best accomplished with niacin among common lipid-lowering drugs. HDL helps remove cholesterol from peripheral tissues and return it to the liver, a process known as reverse cholesterol transport. Niacin increases HDL levels the most by both reducing hepatic production of VLDL (which shifts lipid metabolism in a way that preserves HDL) and decreasing HDL clearance. This makes HDL rise more pronounced with niacin than with other agents. Niacin also lowers triglycerides and can modestly lower LDL, adding to its overall lipid benefits. In contrast, statins primarily target lowering LDL with only modest increases in HDL, fibrates focus on lowering triglycerides and can raise HDL but not as robustly as niacin, and bile acid sequestrants mainly reduce LDL with less impact on HDL.

Raising HDL cholesterol is best accomplished with niacin among common lipid-lowering drugs. HDL helps remove cholesterol from peripheral tissues and return it to the liver, a process known as reverse cholesterol transport. Niacin increases HDL levels the most by both reducing hepatic production of VLDL (which shifts lipid metabolism in a way that preserves HDL) and decreasing HDL clearance. This makes HDL rise more pronounced with niacin than with other agents.

Niacin also lowers triglycerides and can modestly lower LDL, adding to its overall lipid benefits. In contrast, statins primarily target lowering LDL with only modest increases in HDL, fibrates focus on lowering triglycerides and can raise HDL but not as robustly as niacin, and bile acid sequestrants mainly reduce LDL with less impact on HDL.