Fish Oil, Fenofibrates and Triglycerides

From POZ Magazine, reporting on a study:

December 17, 2007
Fish Oil Plus Fenofibrate Good for High Triglycerides
Fish oil supplements, combined with the lipid-lowering drug fenofibrate (Tricor), reduced triglycerides to normal levels in a significant percentage of HIV-positive people who did not respond to either therapy alone, according to the results of an AIDS Clinical Trials Group (ACTG), made available online in advance of publication in the Journal of Acquired Immune Deficiency Syndromes.
John Gerber, MD, of the Department of Medicine at the University of Colorado Health Sciences Center in Denver, and his colleagues enrolled 100 HIV-positive people whose antiretroviral regimen had caused their triglyceride levels to increase above 200 mg/dL, which is the top limit of the healthy range. Elevated triglycerides can lead to pancreatitis and have been linked to a higher risk of heart disease.
For the first eight weeks of the study, the study volunteers took either 3 grams of fish oil twice daily or 160 mg of fenofibrate once daily. If their triglyceride levels were not below 200 mg/dL after nearly two months, patients in the study were given both treatments to use at the same time.
After the first eight weeks in the study, 8.5 percent of the fish oil-treated patients and 16.7 percent of the fenofibrate-treated patients had triglyceride levels within the normal range. Of the 75 people who went on to take both drugs, 22.7 percent saw their triglyceride levels drop below 200 mg/dL. This was statistically significant, meaning that it was too large of a difference to have happened by chance. The researchers state that these results are sufficiently promising to warrant further study of this combination.




Niacin and statin combination therapy to protect against risk of heart attack or stroke

The National Institutes of Health is funding a large-scale study in the US and Canada to follow thousands of heart patients who take niacin plus a statin drug, versus those taking only a statin drug. A widely-held expectation is that the study will add further support to the already substantial case for niacin + statin as the therapy of choice to protect against heart attack or stroke for those with cardiovascular disease.

While statins have shown effectiveness in reducing LDL, the so-called “bad cholesterol,” it is niacin that takes the prize in increasing levels of HDL, also known as the “good cholesterol.” In past studies, niacin was found to increase HDL by as much as 35%, while also reducing artery-clogging triglycerides as much as 50%. Moreover, niacin was the subject of landmark long-term research begun in the 1970s, which showed it substantially reduced second heart attacks and strokes in men who had suffered a first heart attack.  

A recent analysis of 23 clinical trials conducted by researchers at the University of Washington concluded that increasing HDL by 30% and decreasing LDL by 40% would reduce the risk of heart attack or stroke by 70% in a typical cardiovascular patient. Thus, combining the HDL-raising capacity of niacin with the LDL-lowering capacity of statin drugs may offer one of the most promising avenues toward improving cardiovascular care and increasing survival rates.

Notes and warnings:

–Statin drugs have side effects, so their use is not without risk (see the post on this blog, “When FDA-approved drugs stumble…”

–An earlier study led by Dr. B Greg Brown of the University of Washington reported that antioxidant vitamins such as vitamin E, vitamin C, and b carotene curb the rise in HDL levels seen with the niacin + statin combination. Accordingly, patients using this combination therapy may be advised to avoid antioxidant supplementation. (New England Journal of Medicine 2001;345:1583-92).

–For futher details on suggested use, see NYBC’s description of Niacin 100mg and Niacin 400mg. These are timed-release formulas; also provided are guides for minimizing the “flushing” that can accompany niacin use. Note that, as always, NYBC recommends consulting a health care professional about use of this dietary supplement.

–Background on niacin and the renewed interest in it as part of a combination therapy for cardiovascular patients: Michael Mason, “An Old Cholesterol Remedy is New Again,” in The New York Times, Jan. 23, 2007.