Can Lipid-Lowering Drugs Be Used to Increase HDL Levels?
Although low levels of high-density lipoprotein (HDL) cholesterol are usually accompanied by other lipid abnormalities, low HDL levels in isolation may signal a risk of premature coronary artery disease in nonobese, nonsmoking patients who exercise regularly. Zema studied the efficacy and safety of gemfibrozil and niacin, alone and in combination, in increasing low HDL levels in patients with coronary artery disease or peripheral artery disease and no other lipid abnormalities. The 23 patients (22 men and one woman) in the open-label crossover study had HDL levels less than 40 mg per dL (1.05 mmol per L). Twenty-two had coronary artery disease, and one had peripheral vascular disease. They were randomly assigned to receive 600 mg of gemfibrozil twice daily, 100 to 250 mg of niacin three times daily or a combination of 600 mg of gemfibrozil twice daily and the maximal tolerated dosage of niacin. Patients received maximal dosages of the agents for three months, if tolerated, and then cro
