Pioglitazone vs Placebo in Combination With Niacin Extended Release on Low HDL

Inclusion Criteria

• Men and women between the ages of 18 and 75
• HDL-C ≤ 40 mg/dL for Men and HDL-C 130/>85 mmHg in untreated patients OR use of any antihypertensive agent.
• Fasting glucose > 100 mg/dL but 150 mg/dL

Exclusion Criteria

• Diabetes or use of anti-hyperglycemic medication in the last 3 months (subjects with a fasting blood glucose of > 110 mg/dL will have an oral glucose tolerance test (OGTT) to rule out diabetes mellitus).
• Subjects on statin therapy may be enrolled, but only if they have been on a stable dose for at least 3 months, and are not expected to require titration of statin therapy during the course of the study.
• Uncontrolled hypertension (defined as systolic bp > 180, diastolic BP > 100).
• Triglycerides > 400 mg/dL
• LDL-cholesterol level > 190 mg/dl
• History of chronic renal insufficiency (serum creatinine >2.0 mg/dl).
• History of liver disease or abnormal liver function tests (LFTs) (>2x upper limit normal)
• Hemoglobin < 10 mg/dL
• History of congestive heart failure (NYHA Class III or IV)
• Women who are pregnant or lactating
• History of a non-skin malignancy within the previous 5 years
• Any major active rheumatologic, pulmonary, or dermatologic disease or other chronic inflammatory condition
• Surgery in the last 90 days
• History of HIV positive
• Active alcohol or drug abuse
• Active peptic ulcer disease
• Gout attack within the past 6 months
• Participation in an investigational drug study within 6 weeks
• Serious or unstable medical or psychological conditions that, in the opinion of the investigator, would compromise the subject's safety or successful study participation
• Subjects on warfarin may be enrolled, but they will be excluded from the optional adipose biopsy.