In spite of a better knowledge of risk factors and better recognition and availability of more efficacious drugs for lowering serum cholesterol and triglycerides, mortality from cardiovascular disease continues to occur in 2/3 of patients treated with statins, and to increase worldwide by about 25% (Libby, 2005). Niacin (nicotinic acid) at 1–2 g day1 decreases low-density lipoprotein and triglycerides, while increasing high-density lipoprotein levels (Carlson, 2005). Moreover, niacin and a statin together have superior lipoproteinlowering profile (Brown et al., 2001), as also shown for slow-release niacin combined with lovastatin (Gupta and Ito, 2002). However, a limiting adverse effect in patients receiving immediate- or sustained-release niacin is the rapid development of significant cutaneous warmth and vasodilation, referred to as ‘flush’, which severely limits compliance (Gupta and Ito, 2002).
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