Which dietary supplement is recommended for a patient with elevated LDL and decreased HDL?

• A. thiamine
• B. folate
• C. retinol
• D. niacin

Answer: (D)

Raising HDL while lowering LDL is a key goal in managing dyslipidemia. Niacin (nicotinic acid) is the supplement that most effectively increases HDL levels and also helps modestly reduce LDL and triglycerides. Mechanistically, it decreases hepatic VLDL synthesis and slows HDL catabolism, which raises HDL, while the indirect effects contribute to lower LDL and triglycerides.

In contrast, thiamine, folate, and retinol do not have meaningful lipid-modifying effects relevant to raising HDL or lowering LDL, so they aren’t the typical choices for this lipid pattern. Be aware that niacin can cause flushing and other side effects (hyperglycemia, hyperuricemia, hepatotoxicity) at higher doses, so its use requires consideration and monitoring.