The Real Story On Niacin: Niacin associated with significant reductions in cardiovascular disease and mortality

You may have heard some recent reports on Niacin (one of the B-vitamins) that seemed to suggest it wasn’t of benefit for cardiovascular disease. Actually, the recent studies fueling these reports only looked at certain special forms of niacin taken together with a statin drug. These studies proved a disappointment to the statin drug makers, because the research didn’t show any additional benefit in adding the niacin. (By the way, some researchers have pointed out problems with the special forms of niacin used in these studies.)

Given the confusion in some news reports about Niacin, we at NYBC think it’s important to repeat what researchers stated about Niacin in a March 2014 article in the Journal of Cardiovascular Pharmacology and Therapeutics. This article reviewed the recent Niacin studies, and also reiterated the well-known and well-documented benefits of Niacin for cardiovascular health:

1. In a long-term study called the Coronary Drug Project, “niacin treatment was associated with significant reductions in cardiovascular events and long-term mortality, similar to the reductions seen in the statin monotherapy trials.”

2. “In combination trials, niacin plus a statin or bile acid sequestrant produces additive reductions in coronary heart disease morbidity and mortality and promotes regression of coronary atherosclerosis.”

3. Niacin is the “most powerful agent currently available” for RAISING levels of HDL-C (high-density lipoprotein cholesterol, the so-called “good cholesterol”); and it can also REDUCE levels of triglycerides and LDL-C (low-density lipoprotein cholesterol, the so-called “bad cholesterol”).

Here’s the reference for these three important points about Niacin:

Boden, W E, Sidhu M S, & Toth P P. The therapeutic role of niacin in dyslipidemia management. J Cardiovasc Pharmacol Ther. 2014 Mar;19(2):141-58. doi: 10.1177/1074248413514481.

NOTE: NYBC stocks Niacin No-Flush (Source Naturals): http://nybcsecure.org/product_info.php?cPath=50&products_id=439; Niacin TR Niatab 500mg (Douglas): http://nybcsecure.org/product_info.php?cPath=50&products_id=249; and
Niacin TR Niatab 100mg (Douglas) http://nybcsecure.org/product_info.php?cPath=50&products_id=252

As always, we strongly recommend that you consult your healthcare provider when using supplements.

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Fish and Omega-3 Fatty Acids: American Heart Association Recommendation

This recommendation appears on the website of the American Heart Association:  
Omega-3 fatty acids benefit the heart of healthy people, and those at high risk of — or who have — cardiovascular disease. We recommend eating fish (particularly fatty fish) at least two times a week.  Fish is a good source of protein and doesn’t have the high saturated fat that fatty meat products do.  Fatty fish like mackerel, lake trout, herring, sardines, albacore tuna and salmon are high in two kinds of omega-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA).To learn about omega-3 levels for different types of fish — as well as mercury levels, which can be a concern — see our Encyclopedia entry on Fish, Levels of Mercury and Omega-3 Fatty Acids.We also recommend eating tofu and other forms of soybeans, canola, walnut and flaxseed, and their oils. These contain alpha-linolenic acid (LNA),  which can become omega-3 fatty acid in the body. The extent of this modification is modest and controversial, however. More studies are needed to show a cause-and-effect relationship between alpha-linolenic acid and heart disease.The table below is a good guide to use for consuming omega-3 fatty acids.Summary of Recommendations for Omega-3 Fatty Acid Intake

Population Recommendation
Patients without documented coronary heart disease (CHD) Eat a variety of (preferably fatty) fish at least twice a week. Include oils and foods rich in alpha-linolenic acid (flaxseed, canola and soybean oils; flaxseed and walnuts).
Patients with documented CHD Consume about 1 g of EPA+DHA per day, preferably from fatty fish.  EPA+DHA in capsule form could be considered in consultation with the physician. 
Patients who need to lower triglycerides  2 to 4 grams of EPA+DHA per day provided as capsules under a physician’s care. 

 Patients taking more than 3 grams of omega-3 fatty acids from capsules should do so only under a physician’s care.  High intakes could cause excessive bleeding in some people.

Background

In 1996 the American Heart Association released its Science Advisory, “Fish Consumption, Fish Oil, Lipids and Coronary Heart Disease.” Since then important new findings have been reported about the benefits of omega-3 fatty acids on cardiovascular disease.  These include evidence from randomized, controlled clinical trials.  New information has emerged about how omega-3 fatty acids affect heart function (including antiarrhythmic effects), hemodynamics (cardiac mechanics) and arterial endothelial function.  These findings are outlined in our November 2002 Scientific Statement, “Fish Consumption, Fish Oil, Omega-3 Fatty Acids and Cardiovascular Disease.”

The ways that omega-3 fatty acids reduce CVD risk are still being studied.  However, research has shown that they

  • decrease risk of arrhythmias, which can lead to sudden cardiac death
  • decrease triglyceride levels
  • decrease growth rate of atherosclerotic plaque
  • lower blood pressure (slightly)

What do epidemiological and observational studies show?

Epidemiologic and clinical trials have shown that omega-3 fatty acids reduce CVD incidence.  Large-scale epidemiologic studies suggest that people at risk for coronary heart disease benefit from consuming omega-3 fatty acids from plants and marine sources.

The ideal amount to take isn’t clear.  Evidence from prospective secondary prevention studies suggests that taking EPA+DHA ranging from 0.5 to 1.8 grams per day (either as fatty fish or supplements) significantly reduces deaths from heart disease and all causes.  For alpha-linolenic acid, a total intake of 1.5–3 grams per day seems beneficial.

Randomized clinical trials have shown that omega-3 fatty acid supplements can reduce cardiovascular events (death, non-fatal heart attacks, non-fatal strokes).  They can also slow the progression of atherosclerosis in coronary patients.  However, more studies are needed to confirm and further define the health benefits of omega-3 fatty acid supplements for preventing a first or subsequent cardiovascular event.  For example, placebo-controlled, double-blind, randomized clinical trials are needed to document the safety and efficacy of omega-3 fatty acid supplements in high-risk patients (those with type 2 diabetes, dyslipidemia, hypertension and smokers) and coronary patients on drug therapy.  Mechanistic studies on their apparent effects on sudden death also are needed.

Increasing omega-3 fatty acid intake through foods is preferable.  However, coronary artery disease patients may not be able to get enough omega-3 by diet alone.  These people may want to talk to their doctor about taking a supplement.  Supplements also could help people with high triglycerides, who need even larger doses.  The availability of high-quality omega-3 fatty acid supplements, free of contaminants, is an important prerequisite to their use.

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For NYBC’s fish oil supplement, see the product description for Jarrow’s Max DHA.

And we add some general dietary advice about fat:

Remember that the balance of fats you eat is the first, most important step to consider. Dump the hydrogenated fats (found in cookies, margarine and lots of things; read labels!), limit saturated fat intake (dairy, red meat, fried stuff) and increase good fat intake (deep sea fish like salmon, tuna; olive oil, hemp oil, etc.) Lastly: in controlling cholesterol through modifications in diet, it’s not always emphasized enough that sugar intake will also influence your cholesterol levels!