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Evidence implicating hyperlipidemia in the pathogenesis of atherosclerosis continues to accumulate. As a result, methods for reducing lipid levels in man, both dietary and pharmacological, become increasingly important. Any practical lipid control program must be economical and must not produce undesirable side eff ects.Altschul et al. first reported a decrease in plasma cholesterol following large oral doses of nicotinic acid.'-Many subsequent studies have confirmed these results .2, 3 Large scale prospective clinical trials are underway at present. Studies published to date, however, contain few references to experiences totaling more than five years of continuous nicotinic acid therapy and evidence of the safety of long term use is still lacking. Nicotinic acid has been used as a treatment for hypercholesterolemia in this institution since 1957. We have reviewed our clinical experience with this drug in terms of its efficacy in lowering plasma cholesterol and its toxicity and practicality as a longterm agent. This report concerns 160 patients, some of whom have been followed for more than a decade. Our experience includes 868 patient years of treatment. MATERIALS AND METHODSPatients entered the study from 1957 through 1968. Patients were seen initially in the Vascular Clinic for evaluation of various clinical manifestations of atherosclerosis. Patients whose plasma cholesterol was greater than 260 mgs. per cent were instructed in a diet containing less than 300 mgs. of cholesterol daily and a polyunsaturated to saturated fat ratio of approximately 1.5 to 1. The caloric level was adjusted to bring each patient toward ideal body weight. Patients whose blood cholesterol remained above 260 mgs.% after 8 weeks of diet therapy were selected for treatment. There were four patients in this series whose initial cholesterol was less than 260 mgs.% in whom treatment was started because of clinical evidence of extensive symptomatic atherosclerosis.All patients were screened for secondary causes for hypercholesterolemia such as hypothyroidism, uncontrolled diabetes mellitus, nephrotic syndrome or obstructive biliary tract disease. Unless intercurrent illness demanded hospitalization, all followup examinations were carried out in the outpatient department.

Follow-up on 102 of these subjects showed that 88% saw their physician within two months and 86% were being followed-up regularly after one year by their community physicians. Eighty-six percent of the subjects with diastolic blood pressures greater than 100 mm Hg were still receiving drug therapy after one year follow-up.

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