<International Circulation>:So at the moment you would say we are not at the stage where we should be prescribing niacin or other HDL-raising medications to prevent cardiovascular events?

　　Dr Chapman: I wouldn’t take it to that degree. It is very much a decision of the clinician and equally of the patient. In other words， if the patient considers that the flushing reaction that he or she undergoes can be tolerated then personally I would recommend the use of add-on niacin treatment to statin in very high- and high-risk patients. This question was considered in considerable detail by the European Atherosclerosis Society Consensus Panel and the clinical algorithm that we proposed was if insufficient improvement in the atherogenic lipid triad was seen on statin treatment， then there was the choice of either increasing the statin dose or adding-on niacin or a fibrate. Personally， if we look at the data particularly in diabetics for HDL-raising with fibrate， the data are rather inconsistent and the absolute increases in HDL-C certainly tend to be below 5% and frequently less than 3%. If we do set HDL-raising as a primary goal in attempting to reduce so-called residual risk on statin treatment， certainly our tendency would be to go more towards niacin than towards a fibrate but again this can depend on the absolute level of triglyceride and our ability to reduce that. As we know， the metabolism of triglyceride-rich lipoproteins is a major determinant of HDL levels. So there are a number of factors to consider and I think at this point， in our judgment， that if we had the new preparation of niacin available in France， my colleagues and I would almost certainly tend towards the addition of niacin with a statin in individuals at very high- or high-risk with subnormal HDL-C levels. 

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