I believe niacin is a most important medication for proper lipid metabolism.
I have not seen niacin cause gout in over 10 years of practice, but perhaps
I simply have not recognized it. Niacin can cause some insulin resistance
however, and has a frustrating rash as a common side effect *blocked by
aspirin*. You might try your question to sci.med.cardiology, they can give
you some great references on niacin. My website also has some interesting
articles about niacin and lipid metabolism.

As to my opinion on the rx for low HDL, I think it very important. In view
of gout, if your niacin is causing gout, I would recommend you focus on your
priorities; is having gout worth the benefit of increased HDL? No one can
decide that for you.

If you are taking other medications, you should also focus on them as a
cause. As for rx, my preference is colchicine, 0.6 mg  daily, trying diet
changes first, for at least 6 weeks. Paraffin soaks also work wonders.

I would like to hear from others regarding this lady's problem.

Regards,
Patrick

~~~
Patrick Blanchard, M.D.
Board Certified in Family Medicine