From the FDA Drug Label
At niacin extended-release 2000 mg/day, median changes from baseline (25th, 75th percentiles) for LDL-C, HDL-C, and TG were -3% (-14, +12%), +27% (+13, +38%), and -33% (-50, -19%), respectively
Elevated HDL treatment with niacin extended-release results in a significant increase in HDL-C levels.
- The median percent change in HDL-C from baseline was +27% at a dose of 2000 mg/day 1.
- Women tend to have a greater response to niacin extended-release than men, with a median percent change in HDL-C of +26% at 2000 mg/day, compared to +23% for men 1.
- Niacin extended-release also reduces TG levels and has a moderate effect on LDL-C levels 1, 1.
From the Research
Elevated HDL levels generally don't require specific treatment as high HDL is traditionally considered beneficial for cardiovascular health, but recent research suggests that extremely high HDL may not always be protective and might indicate abnormal cholesterol transport in some individuals. When considering treatment for elevated HDL, it's essential to focus on overall cardiovascular health rather than solely on HDL levels. The most recent and highest quality study, 2, published in 2021, indicates that higher HDL-C is not necessarily protective against cardiovascular disease and can even be harmful in extremely high quantities. Key points to consider in managing elevated HDL include:
- No medications are specifically recommended to lower HDL levels
- Lifestyle modifications such as regular exercise, maintaining a healthy weight, and following a Mediterranean-style diet are crucial for overall cardiovascular health
- Limiting alcohol consumption and avoiding smoking are also important
- If elevated HDL is accompanied by other lipid abnormalities or cardiovascular risk factors, those conditions should be addressed appropriately
- Regular follow-up with a healthcare provider is recommended to monitor the complete lipid profile and overall cardiovascular risk assessment rather than focusing solely on HDL levels
- Niacin therapy, which has been used to increase HDL-C, has been shown to have mixed results in clinical trials and may even increase HDL-associated proteins linked to increased atherosclerotic risk, as seen in studies such as 3 and 4. Therefore, the focus should be on overall cardiovascular health through lifestyle modifications and addressing other lipid abnormalities or cardiovascular risk factors, rather than specifically treating elevated HDL levels.