LDL, triglycerides, and HDL - the so called "good cholesterol" - are lipids, fat-like substances present in the blood. Most of the lipids in the body are manufactured by the liver while some come from our diet. When levels of LDL and/or triglycerides rise or HDL fall below normal levels, a condition called dyslipidemia develops.

Dyslipidemia contributes to the narrowing, hardening and clogging of arteries (atherosclerosis) that can lead to heart attack and stroke.

For patients with dyslipidemia, doctors often initially recommend lifestyle modification that includes eating a healthy diet, quitting smoking, exercising regularly, and maintaining an ideal weight.

For patients who are unable to modify their lifestyle or in whom lifestyle modification is unable to address dyslipidemia, doctors usually prescribe a type of lipid-modifying drug called statin.

"However, statins primarily target LDL only,"says Dr. Nestel, "and studies show that even with optimal lowering of LDL, there is a substantial residual risk of cardiovascular disease. This indicates a need for further interventions on lipids and lipoproteins."

Dr. Nestel says evidence is accumulating that lowering triglycerides and increasing HDL levels, on top of standard LDL lowering, is a more effective way of reducing cardiovascular disease risk.

"Ideally, you should aim for an HDL level of at least 39 mg/dl," he says Dr. Nestel. "Studies have shown that for every 1 mg/dL rise in HDL, your risk of developing cardiovascular disease decreases by 2 to 3 perecent."

According to the latest National Nutrition and Health Survey conducted by the Food and Nutrition Research Intsitute, one out of two Filipino adults has an HDL level below 35 mg/dl.

Among the currently available lipid-modifying drugs, statins give the highest LDL reduction (up to 55 percent) while fibrates offer the best triglyceride lowering capability (up to 50 percent). "But niacin is the most effective HDL-raising agent, capable of boosting good cholesterol levels by up to 35 percent," says Dr. Nestel. "Plus niacin offers other lipid-modifying effects, with an LDL-lowering effect of up to 25 percent and triglyceride-lowering capability of up to 50 percent."

Unfortunately, previous formulations of niacin cause several side effects, the most bothersome of which is flushing. Flushing is the dilation of blood vessels causing redness of the skin coupled with a warming or burning sensation on the face and neck. It is believed that niacin induces the flushing response by triggering the release of prostaglandin D2 (PGD2), a chemical that causes dilation of blood vessels in the skin and flushing symptoms. The understanding of this mechanism opened the possibility of lessening the flushing effect produced by niacin, through new pharmacologic intervention.