By now you have heard about the side effects of this commonly used both over-the-counter and prescription medication to raise HDL and lower LDL. But I finally got the article in the July 17 New England Journal of Medicine and wanted to give you a little more scientific information.
I almost didn’t write this segment because I’ve been overwhelmed with what’s happening in Israel. The good news is that my daughter and her young children came to Los Angeles two days ago. They literally got out on the last flight before the 24-hour closure of the Ben-Gurion airport. I think it’s open now to flights on all airlines and hopefully some of this conflict will be resolved. I can’t stop watching the news and despair over the fighting in Gaza that has destroyed the homes and lives of civilian population that could not or would not find refuge and the hourly bombardments of missiles sent by Hamas to Israel, intended to cause widespread killing of anyone in range. (Thankfully, the iron dome works.) I like everyone, hope that a valid cease fire will be negotiated. But how does one negotiate with a terrorist organization whose goals are to hold on to power and eliminate the country of Israel and it’s citizens from the face of the earth? They show no regard for their civilian population (other than to allow them to shield weapon stores) and take every opportunity to run with cameras to record their suffering, and mourning…and yes, we all have to be appalled. As many of you know, I am on the board of Save the Children. We have programs in Gaza and have tried over the years to improve the health care, education and hope for a better future for the children there. Children are never to blame for conflict and are always the ones who suffer. Unfortunately, it would seem that much of the millions of dollars sent there by so many NGO’s has been used to building tunnels and purchasing weapons rather than for infrastructure and care of the population.
I”ll stop now…I know I am not supposed to wax political, but it’s hard to always be the evidenced based doc.)
So on to niacin… Ever since I went to medical school we’ve been taught that high density lipoprotein or HDL particles help decrease coronary heart disease. The higher the HDL the lower the disease in the general population. Likewise LDL or low density lipoprotein cholesterol increases plaque formation and enhances heart disease. The question is, are these two types of cholesterol risk factors or signs of heart disease or do they indeed have an impact in causing heart disease? The articles published in the July 17 New England Journal of Medicine may have changed our assumption of causation. In the heart protection study two- treatment of HDL to reduce the incidence of vascular events (HPS 2-THRIVE), 25,673 adults ages 50 to 80 with underlying cardiovascular disease were given either an extended release niacin combined with laropiprant (an agent that helps prevent flushing) or placebo and were followed for four years. Prior to the randomization, they had been put on statin based therapy. During the trial, the participants who received niacin raised their HDL 6 mg/dL and lowered the LDL cholesterol 10 mg/dL as well as their trygliceride level 33 mg/dL compared to those receiving placebo. Despite these favorable responses there was no significant reduction in major vascular events. Moreover, there were significant side effects which included an increase in gastrointestinal complications, infections, muscular skeletal pain, development of diabetes and a 9% increase in the risk of death. The American Heart Association now gives a very limited and cautious recommendation regarding the use of niacin…They state that niacin may still have a role in patients with very high risk for cardiovascular events who truly have contraindications for taking statins and who have a high LDL-cholesterol level. They also suggest that there may also be a use for those who have very high triglycerides and for whom it could be used to prevent pancreatitis. In an editorial in the same journal the author suggests that “it is time to face the fact that increasing the HDL cholesterol level in isolation seems unlikely to offer cardiovascular benefit”.
So before you take niacin as a so-called easier way to deal with cholesterol problems, please consult your physician. Next week, I hope I can write an article that doesn’t also deal with the middle east conflict.