You may have read worried news reports earlier this year about a study of niacin + a statin drug used to lower cholesterol (lipids). The study was stopped prematurely because researchers detected a small increase in strokes among participants taking the niacin +simvastatin (Zocor) combination. This was quite a surprise to scientists, because niacin (a B-vitamin) has a 50-year history of safe and effective use for normalizing lipid levels, and the suggestion that a statin drug/niacin combination might carry even a slight extra cardiovascular risk was disturbing.
We were therefore glad to see the Canadian AIDS Treatment Information Exchange (CATIE) review and clarify the results of this study, while at the same time reporting on an important new piece of research about niacin, lipid control, and HIV. (You can find the full CATIE reporting about niacin at www.catie.ca.) CATIE’s view, in line with other cautionary voices, stresses that the niacin/statin study data do not show any clear connection between niacin and increased strokes. And it’s also true that, through 50 years of research on niacin and lipids, there’s never been any evidence of such a connection. In short: expect more examination of the issue, but don’t jump to any conclusions—there’s just not the evidence to support dropping niacin for lipid control.
Coincidentally, as the niacin/statin study was being suspended, results of another trial involving niacin for lipid control were being published. This research, conducted at Baylor College of Medicine in Texas, looked at a combination of niacin, fenofibrate (a prescription drug used to lower cholesterol), diet and exercise for lipid management among people with HIV. Called the Heart Positive study, this investigation found that a combination of high-dose niacin, together with fenofibrate, diet and exercise was clearly the best strategy for managing lipids in a group of more than 100 people with HIV. And, significantly–there were no signs in this research that niacin was unsafe.
We certainly urge all our members who use or are thinking of using niacin as part of a strategy to control lipids to talk to their doctors about the recent research. (You may even want to share the CATIE info with your physician.) As we’ve said above, we don’t see clear evidence that niacin poses extra, unexpected risks. Meanwhile, its benefits continue to be documented in research like the Heart Positive study. As always, we need to keep up with research news—and also maintain a bit of skepticism in judging how that news gets reported.
For more information on Niacin, see the NYBC entries:
or the lower, starter dose: