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.