Niacin and Heart Disease Mystery

niacin_heart_diseaseDoes niacin help slow the progression of heart disease and reduce the risk of dying from it? Yes, if you give it to the right group of people and take it in the right form and dose.

Last week it was announced that a large and expensive study (AIM-HIGH), funded by U.S. taxpayers and Abbot Laboratories, was stopped early. The niacin used in the study was Niaspan®, a high-dose, extended release form made by Abbot. The AIM-HIGH study was designed to find out whether the combination of a statin drug for lowering cholesterol and niacin for raising “good” HDL cholesterol and lowering triglycerides, would have more benefit than the statin alone.

All of the participants in the study had low HDL and high triglycerides, and all had heart disease. Taking high doses of niacin, also called vitamin B3 and nicotinic acid, has been shown conclusively to raise HDL cholesterol and lower triglycerides, as it did in the AIM-HIGH study. So why wasn’t the combination of the two drugs more helpful than statins alone? There are already multiple studies showing improvement in heart disease patients taking niacin. The HDL-Atherosclerosis Treatment Study (HATS), which compared patients taking a placebo with those taking niacin and a statin, showed a 90% decrease in death from heart disease among those taking the drugs, not to mention significant lowering of LDL cholesterol, rise in HDL, and lowering of triglycerides.

Why Niacin Didn’t Help

It’s not helpful to just whack down HDL and triglyceride numbers with a powerful drug, without addressing the underlying causes of heart disease. The disease will progress if lifestyle changes aren’t made, regardless of the numbers. Niaspan® is a high dose, extended release form of niacin. Extended release niacin has been shown in past studies to be very hard on the liver. Statins are also hard on the liver. And it’s likely that study participants were taking other types of drugs, such as those for lowering blood pressure. The bottom line is, if liver function is compromised, the body can’t heal. This seems to be a concept that Western medicine can’t get its collective head around. Virtually every prescription drug adds to the workload of the liver, and every drug that’s added geometrically increases the load, and the side effects. Most seniors are on at least eight prescription drugs.

Another important concept in taking niacin and other drugs is “bigger and faster is not better.” Just because a dose of 2000 mg of niacin daily causes the biggest changes in cholesterol numbers without immediately damaging the liver, doesn’t mean that’s the best way to take it. A lower dose of 500 mg daily will also improve cholesterol numbers over time, with fewer potential risks and side effects. Why use a chain saw on a problem when a butter knife will do?

Plain immediate-release niacin, taken in increasing doses (starting with 250 mg) appears to be the safest way to take niacin and spare the liver. It can cause a short-term unpleasant flushing at first, but this tends to disappear over time.

There are two forms of niacin, inositol hexaniacinate and nicotinamide, that do not cause flushing, but there’s no evidence that they help improve cholesterol numbers.

Here’s a article by Dr. John Lee and myself with details on cholesterol numbers and what they really mean: What Your Dr May Not Tell You about Cholesterol.

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