Low plasma concentrations of high density lipoprotein (HDL) cholesterol are an independent risk factor for atherosclerotic cardiovascular diseases. Raising HDL cholesterol levels is therefore one of the therapeutic strategies for the prevention of cardiovascular diseases. Besides the development of new HDL cholesterol-elevating pharmacological procedures, the oldest lipid-modifying drug, nicotinic acid (niacin), has recently attracted new interest. It has by far the strongest HDL cholesterol-elevating effect among the drugs currently approved for the treatment of lipid disorders. The recently identified receptor for nicotinic acid, GPR109A, is expressed in adipocytes and various immune cells. It has the expected pharmacological properties, and studies in mice lacking GPR109A have shown that it mediates the acute pharmacological effects of nicotinic acid. Recent progress in the understanding of the physiological and pharmacological role of the nicotinic acid receptor will be summarized and its potential use as a new target for the development of anti-dyslipidemic drugs to prevent and treat cardiovascular diseases will be discussed.