Nicotinic Acid ─ the Broad Spectrum Lipid Drug

Some fifty years ago the Canadian pathologist Rudolf Altschul discovered that nicotinic acid in gram doses lowered plasma cholesterol in man, an effect surprisingly not shared by nicotinamide [1]. Altschul had also shown that nicotinic acid lowered plasma cholesterol and reduced aortic atherosclerosis in the cholesterol-fed rabbit. At that time, 5 years before bile acid sequestrants and 6-8 years before clofibrate were available as lipid lowering drugs nicotinic acid was used by several groups for the treatment of dyslipidemia. Its clinical use is, however, limited by the flush which occurs as a regular unpleasant but harmless side effect once treatment with nicotinic acid is started. I have used nicotinic acid in clinical practice as well as in experimental medicine since the 1960s and I will briefly discuss past, present, and future aspects of nicotinic acid in clinical lipidology.