The Effects of Niacin on Lipoprotein Subclass Distribution

John M. Morgan, MD; Christina M. Carey, PA-C; Anne Lincoff, MD; David M. Capuzzi, MD, PhD

In This Article


The increasing recognition of the importance of the lipid and lipoprotein subclasses in the atherogenic process is leading to renewed interest in the properties of niacin. Niacin effectively modifies all major lipids and lipoproteins with respect to both their quantity and quality. It is the most effective agent currently available for raising low levels of HDL cholesterol, and this change is predominantly attributable to an increase in the larger cardioprotective HDL2 subclass and in the level of HDL apo A-I. Niacin has more moderate LDL cholesterol-lowering efficacy, but this change is associated with an increase in LDL particle size and a shift to the less atherogenic, larger LDL subclass. Furthermore, niacin's effects appear to be greater in individuals with LDL pattern B, characterized by a predominance of small, dense LDL particles. Niacin, alone or in combination, represents a valuable option for clinicians in the management of dyslipidemia.