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Berkeley Wellness Alerts
January 24, 2012 | Comments: 3
Niacin + Statins: The Mighty Duo?
Doctors often prescribe both a statin and niacin to improve cholesterol levels. But results from a long-awaited federal study have called this practice into question—at least for some people.
The main goal of cholesterol treatment is to lower LDL (“bad”) cholesterol. Statins do this much better than niacin does. But niacin has the advantage of raising HDL (“good”) cholesterol much more than statins do. It also lowers triglycerides, fats in the blood that can increase the risk of heart disease. For these reasons, niacin may be a good option for people who can’t tolerate statins well and for those who have very low HDL and/or high triglycerides. Moreover, niacin helps people who have elevated levels of small, dense LDL particles, which increase coronary risk.
Two Better than One?
Some people are advised to take both a statin and niacin if they have not responded well to either drug alone or if they have low HDL and/or high triglycerides. The combination improves cholesterol levels more than either drug alone, but it has not been clear whether it is better at preventing heart attacks than a statin alone. That’s what the new study, reported in December in the New England Journal of Medicine, looked at.
Called AIM-HIGH, the study involved 3,400 people with a history of cardiovascular disease who were already taking a statin to lower their LDL but still had low HDL and high triglycerides. Their statin doses were adjusted so they achieved the LDL target of less than 80. Some subjects were then also given high-dose extended-release prescription niacin (Niaspan), with the expectation that it would offer extra protection by raising HDL and lowering triglycerides.
The study was stopped after 32 months when, surprisingly, it became clear that the combination group, despite its higher HDL levels, did not have fewer heart attacks or other cardiovascular events than the statin-only group—and had slightly more strokes.
What to do
If you are taking niacin, don’t stop because of this study, at least not without consulting your doctor. This was a select group of older patients with existing coronary heart disease who had already achieved very low LDL levels. It’s possible that once LDL is so low, raising HDL may not matter much—that is, there may be little room for further reduction in cardiac risk.
Niacin may still provide added benefits for people with a different risk profile or those who have not reduced their LDL level so dramatically. Moreover, none of the previous studies on niacin found an increased risk of stroke, and many experts believe this was a statistical fluke in the new study.
A much larger study of a niacin/statin combination is now underway and the results may clarify matters. Results are expected in 2013.
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When will we stop doing studies that don't measure all the key components of good cholesterol management. This includes blood values of Vitamin D and Co Q 10. Many of the variables seen are a result of these nutrient deficiencies or other nutrient deficienies that are not measured, and/or the impact of toxins, such as Rx (statins included) or OTC drugs that negatively impact liver function.
Posted by: tbran | January 28, 2012 7:54 AM
After I went on statins, I developed severe problems with coordination and some muscle problems. At one point, I had trouble with balance and had a halting gait when walking. I even fell a few times. I went off statins and saw improvement, but don't feel I've regained a total recovery as some of the leg weakness continued.
I also took Nexium and told my doctor it was giving me headaches. I went on Prevacid which stopped that problem. Then I read the information and it hit me. These drugs can lead to leg weakness and dizzyness through the depletion of magnesium. I have increased my magnesium intake and see much improvement. Now I wonder if statins also deplete magnesium which would be a "double whammy." My experiment continues.
Posted by: Dr. Know | January 28, 2012 12:05 PM
Well problems with the muscles from statin use is not new and in fact it is a contra-indication and for the simva-statin Zocor 80 mg. dose the FDA issued a warning last July regarding issues with musclke and said to curtain the dose. Dr. Stephanie seneff has writen a few articles explaining the mechanisms for the muscle issues as well as a hypothesis of low cholesterol and low fat being an issue for alzheimer's Disease which is actually quite compelling.
The bottom line is just like the commercial, "When diet and exercise is just not enough", then you need a statin. But one thing nobody will ever do is a study to explain what is "diet and exercise"? And what is "not enough"? A recent article ppublished in the NY Times discussed a recent study on arthritis sufferers who were asked to exercise to reduce the potential sysmptoms of their arthritis. They all wore an accelerometer for a week that was designed to track their exercise activity. At the end of the week they all handed in their devices and then were asked questions regarding their exercise. What was discovered was that people were thinking tht they had vigorously exercised when in fact they had really not done much at all. Walking a half flight a stairs in a week was not exercise. so given this background the drug companies win hands down since it is easier to pour a half glass of water and swallow a pill than prepare good food and exercise. We need to better define what "diet and exercise is so people can have an idea of when they are truly not effective.
Posted by: larrygoldfarb | January 30, 2012 2:04 PM