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Although elevations in LDL cholesterol have long been considered the primary risk factor for coronary heart disease (CHD), low HDL levels and high triglyceride levels are now also recognized as independent risk factors.

The standard therapeutic approach for cholesterol reduction is statin drug therapy. However, while statin drugs are recognized for their profound ability to lower LDL cholesterol levels, their effect on triglycerides and HDL cholesterol is minimal.

Nicotinic acid (niacin) is currently recognized as the most potent agent for elevating HDL cholesterol in addition to lowering triglycerides, but various forms of niacin are currently available, and not all forms have equal efficacy. In this review article, Levy et al examined the results of previous combination therapy trials that involved the use of statins and extended release (ER) niacin.

After thorough review of the data, the authors support the notion that combination therapy is a more effective tool for reducing CHD risk and also improving long-term outcomes.

Levy, DR et al. "Combination Niacin and Statin Therapy in Primary and Secondary Prevention of Cardiovascular Disease." Clin Cardiol. 28, 317-320. (2005).

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