Which lipid-modifying agent is most appropriate to increase HDL?

Which lipid-modifying agent is most appropriate to increase HDL?

• A. Niacin
• B. Simvastatin
• C. Bezafibrate
• D. Ezetimibe

Answer: (A)

To raise HDL levels, you want an agent that has a strong effect on HDL, not just modestly raise it. Niacin (nicotinic acid) increases HDL cholesterol more than the other options. It does this by actions that slow the breakdown and clearance of HDL particles and by boosting apoA-I production, leading to a substantial rise in HDL-C. The other choices primarily target LDL or triglycerides and only modestly raise HDL. Simvastatin lowers LDL with some small HDL boost; bezafibrate (a fibrate) can raise HDL but usually not as much as niacin; ezetimibe mainly reduces intestinal cholesterol absorption and has little effect on HDL. So niacin is the best choice when the goal is to increase HDL significantly. Keep in mind niacin’s possible side effects, such as flushing and potential impacts on liver, glucose, and uric acid levels.

To raise HDL levels, you want an agent that has a strong effect on HDL, not just modestly raise it. Niacin (nicotinic acid) increases HDL cholesterol more than the other options. It does this by actions that slow the breakdown and clearance of HDL particles and by boosting apoA-I production, leading to a substantial rise in HDL-C.

The other choices primarily target LDL or triglycerides and only modestly raise HDL. Simvastatin lowers LDL with some small HDL boost; bezafibrate (a fibrate) can raise HDL but usually not as much as niacin; ezetimibe mainly reduces intestinal cholesterol absorption and has little effect on HDL.

So niacin is the best choice when the goal is to increase HDL significantly. Keep in mind niacin’s possible side effects, such as flushing and potential impacts on liver, glucose, and uric acid levels.