<International Circulation>:So at the moment， would you suggest to clinicians that if they see the hallmarks of atherogenic dyslipidemia i.e. raised triglycerides and low HDL-C， that they should be trying to treat these levels after achieving target levels of LDL?

　　Dr Chapman: Certainly we would and in our outpatient prevention clinics in Paris in our very high- and high-risk patients we introduce lifestyle measures and nutritional advice because they can be very effective particularly in reducing triglyceride levels， and to a limited degree， in raising HDL. For example， cessation of smoking can raise HDL by 5-10%. Thirty to forty-five minutes of moderate exercise every day can raise HDL-C again by 5-10%. We believe that those effects potentially are cardio-protective. So certainly lifestyle must be considered. Our approach at the moment is lifestyle and first-line statin. In France， we do not have a form of niacin that is readily available and we are currently awaiting the launch of a new preparation which involves the addition of an inhibitor of the flushing reaction， an inhibitor of the so-called DP1 receptor， associated with an extended release form of niacin. It is true that the database for niacin overall is positive in terms of the impact of niacin on atherosclerotic plaque progression and events， but we really don’t have a recent， progressive， rigorously controlled， randomized controlled trial with niacin to satisfy us in terms of the efficacy of niacin in reducing cardiovascular events. There will however hopefully be in early 2013， the results of the Heart Protection Study， HPS2-THRIVE Trial， which is a very large trial of more than 20000 individuals almost worldwide， a significant proportion of whom are diabetic， and this trial involves patients first being brought to LDL goal with a statin and then randomized either to placebo or add-on niacin and in this case， niacin with a DP1 inhibitor. That trial is particularly important because of its size in enabling us to answer the question as to whether the HDL raising component of niacin really is effective across a wide range of clinical phenotypes involving the atherogenic lipid triad.

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