From the Guidelines
Niacin is the most effective medication for improving HDL cholesterol levels, typically raising HDL by 15-35%. This is based on the evidence from 1, which suggests that niacin can significantly increase HDL cholesterol levels, particularly when used at modest doses (750 – 2,000 mg/day).
Mechanism of Action
The mechanism of action of niacin involves increasing HDL production and promoting reverse cholesterol transport. Other medications, such as fibrates (e.g., fenofibrate and gemfibrozil) and statins, can also increase HDL levels, although to a lesser extent. Fibrates can increase HDL by 5-15%, while statins have a modest effect on HDL, raising levels by 5-10%.
Dosage and Administration
Niacin is available in immediate-release form (starting at 100mg daily, gradually increasing to 1-2g three times daily) or extended-release form (500-2000mg daily). Fibrates like fenofibrate and gemfibrozil are often prescribed at doses of 145mg daily for fenofibrate or 600mg twice daily for gemfibrozil.
Lifestyle Changes
It's essential to note that medication should complement lifestyle changes like regular exercise, weight management, smoking cessation, and moderate alcohol consumption, which can also significantly improve HDL levels. As stated in 1, combination therapy, including statins and other medications, may be necessary to achieve treatment targets, particularly in patients with established cardiovascular disease or high-risk individuals.
Key Points
- Niacin is the most effective medication for improving HDL cholesterol levels
- Fibrates and statins can also increase HDL levels, although to a lesser extent
- Lifestyle changes, such as regular exercise and weight management, can also improve HDL levels
- Combination therapy may be necessary to achieve treatment targets in high-risk individuals, as suggested by 1 and 1.
From the FDA Drug Label
Fenofibrate tablets are indicated as adjunctive therapy to diet to reduce elevated low-density lipoprotein cholesterol (LDL-C), total cholesterol (Total-C), Triglycerides and apolipoprotein B (Apo B), and to increase high-density lipoprotein cholesterol (HDL-C) in adult patients with primary hypercholesterolemia or mixed dyslipidemia. The medication that improves High-Density Lipoprotein (HDL) levels is Fenofibrate 2.
- Key benefits: Fenofibrate increases HDL-C, reduces LDL-C, Total-C, Triglycerides, and apolipoprotein B (Apo B) in adult patients with primary hypercholesterolemia or mixed dyslipidemia.
- Important consideration: The effect of fenofibrate therapy on reducing the risk of developing pancreatitis in patients with markedly elevated levels of serum triglycerides has not been adequately studied 2.
From the Research
Medications that Improve HDL Levels
- Fenofibrate: a fibric acid derivative that improves the lipid profile, particularly triglyceride and high-density lipoprotein-cholesterol (HDL-C) levels in patients with dyslipidaemia 3, 4, 5
- Niacin: improves HDL-C levels and decreases the total cholesterol-to-HDL-C ratio when used in combination with fenofibrate and lifestyle changes 6
Combination Therapies
- Combination of fenofibrate and niacin with lifestyle changes: effective in increasing HDL-C, decreasing non-HDL-C and hypertriglyceridemia, and ameliorating hypoadiponectinemia in patients with HIV/ART-associated dyslipidemia 6
- Statin-fibrate combination therapy: potentially useful strategy to improve lipid and lipoprotein profiles and reduce cardiovascular risk, but may have potential adverse effects on skeletal muscle, including myopathy 7
Key Findings
- Fenofibrate improves HDL-C levels and reduces triglyceride levels in patients with dyslipidaemia 3, 4, 5
- Niacin improves HDL-C levels and decreases the total cholesterol-to-HDL-C ratio when used in combination with fenofibrate and lifestyle changes 6
- Combination of fenofibrate and niacin with lifestyle changes provides maximal benefit in reducing triglycerides, increasing HDL-C, and decreasing non-HDL-C and total cholesterol-to-HDL-C ratio 6