Which lipid-lowering drug class may cause flushing as a side effect?

Niacin, also known as vitamin B3, is well recognized for its lipid-lowering properties, particularly in raising high-density lipoprotein (HDL) cholesterol and lowering triglycerides. One of the notable side effects associated with niacin is flushing, which occurs due to the release of prostaglandins. This flushing sensation can include reddening of the skin, warmth, and itching, primarily affecting the face and upper body. The mechanism involves an increase in blood flow to the skin, leading to the characteristic symptoms.

While statins, fibrates, and bile acid sequestrants are effective in managing lipid levels, they are not commonly associated with flushing as a side effect. Statins primarily work by inhibiting HMG-CoA reductase, which reduces cholesterol synthesis. Fibrates mainly lower triglyceride levels and can also have an impact on HDL, but they do not usually cause flushing. Bile acid sequestrants, on the other hand, bind bile acids in the intestine to lower cholesterol levels, but flushing is not a prevalent adverse effect with this class either. Hence, niacin's distinctive flush reaction sets it apart and confirms it as the correct choice in this context.