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Khaldoon Alaswad MD
Univ.
of Missouri--Kansas City Background: Low levels of high density lipoprotein
cholesterol (HDL-C) are a known risk factor for CAD. Several
drugs are known to be able to raise HDL-C levels, but
single-study comparison of several drugs has rarely been made.
Here we evaluated the effects of niacin, phenytoin, omega-3
fatty acids, and gemfibrozil on levels of HDL-C and its
subfractions (HDL2-C and HDL3-C) in patients with low HDL-C
levels. METHODS: Fifty-four patients with HDL-C of 35 mg/dl or
less were randomly assigned to three months of blinded
treatment with one of four different drugs or placebo. RESULTS: The statistically significant changes (vs.
placebo) in HDL-C and Trig were as follows: Niacin increased
HDL-C by 28% (32± 6.3 to 40.8 ± 7.7 mg/dl; p=0.0001), HDL3-C
and HDL2-C by 18%, 48%, respectively (p<0.0005), and
decreased TG by 43.5%(203 ± 92 to 115 ± 36; p=0.002).
Phenytoin increased HDL2-C by 16% (7.9 ± 2.2 to 9.2 ± 2.78;
p=0.004). Omega-3 fatty acids increased HDL2-C by 19% (7.6 ±
1.6 to 9.0 ± 2.4; p=0.018), and lowered trig by 24% (p=0.02).
Gemfibrozil raised both HDL-C by 17% (32.1 ± 3.7 to 37.4 ±
8.6; p=0.02) and HDL30C by 17% (24.4 ± 3.5 to 28.5 ± 5.2;
p=0.02). Triglycerides was reduced by 49% (p=0.005). Conclusion: The most effective drug for low HDL-C in
this group of patients was niacin.
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