Archive for cholesterol
Statins and risk of polyneuropathy
This article adds more weight to the clinical observation of statin drugs having polyneuropathy as a side effect. A few important things to consider here…the statins lower activity of HMG CoA reductase (one of the enzymes responsible for cholesterol synthesis). They also lower synthesis of CoQ10 at the same time. This is well documented. I’ve always been stumped at this one–CoQ10 is vital for high respiratory tissues such as the heart and skeletal muscle. Hence some of the side effects of the statins are muscle aches. I would guess that the polyneuropathy is also related to reduced CoQ10, which could easily be fixed with supplementation (which any patient on the statins should be put on). The other scary part is recent recommendations that are designed to increase the number of patients that should be on cholesterol lowering meds (three guesses as to who funded THAT study!!). This would increase the side effects we see in this class of drugs.
Neurology — Abstracts: Gaist et al. 58 (9): 1333
Statin Plus Niacin Brings CAD Progression to A ‘Standstill’
It’s amazing that a supplement such as niacin, which has been used for decades longer than any cholesterol lowering medication with less side effects, is still relatively unheard of. The levels of niacin used are several grams per day, and only certain companies offer products with these levels. Side effects of niacin can include liver damage, and niacin should be used only under supervision by a practitioner knowledgeable in its use.
(article) The results of trial evaluating combined therapy in patients with coronary artery disease came as a surprise to researchers. Dr. B. Greg Brown, of the University of Washington, Seattle, reported at the American Heart Association meeting here that the combination of a statin to lower LDL cholesterol and niacin to raise HDL cholesterol “halted disease progression essentially to a standstill.” The study was designed to assess the effects of niacin 2 g to 4 g per day, simvastatin 10 mg to 20 mg per day and four antioxidant vitamins — E, C, beta-carotene and selenium — in various combinations. The investigators randomized 160 patients with documented coronary artery disease to one of four treatment arms: niacin plus simvastatin plus vitamins, niacin plus simvastatin plus placebo or placebo. Dr. Brown reported that the combination of niacin and simvastatin resulted in a 70% reduction in clinical events after 3 years of treatment compared with the rate in the rest of the patients. The reduction in events using statins alone is in the range of 25% to 35%, he noted. With simvastatin plus niacin, HDL levels increased 30% over baseline. Dr. Brown pointed out that statins alone increase HDL levels about 7% to 10%. Dr. Brown said that side effects with niacin were not significant, and that 90% of patients on combination therapy were still in the study at the end of 3 years. “With education, you can get virtually all patients to stay on [niacin]…You need to build up doses over a period of 1 to 2 months. Diabetic patients especially have difficulty adjusting.
Very-low–dose niacin on HDL in patients on long-term statin therapy
Remember that niacin is a well established (but hardly used) therapy for hypercholesterolemia. At therapeutic dosages (roughly 2-3 grams/day) the main side effect is skin flushing. This study uses low dose niacin (100 mg/day) to effect HDL levels. How about adding this to a natural approach to lowering overall cholesterol levels instead of statins?
Efficacy, Safety, and Tolerability of Once-Daily Niacin for Dyslipidemia
The dosages used in this study (1,000 and 1,500 mg) are very reasonable and low enough to avoid most side effects (most notable is flushing). Participants had elevations of HDL up to 25%, which is a large jump unmatched by most pharmaceuticals (most don’t touch HDL levels).
Use of Niacin in the Prevention and management of Hyperlipidemia
With the use of niacin dating back long before the use of many of today’s common meds for high cholesterol levels, it is disappointing that it is not more widely used. This review article address the efficacy and safety of this time-tested treatment for hyperlipidemia. One side effect of niacin therapy, however, is the flushing that comes from the doses needed to achieve a clinical response (usually 1500-3000 mg). I have read that using one baby aspirin 1/2 hour before taking the niacin can de-activate the histamine release and prevent the flushing.
Prog Cardiovasc Nurs 6(1):14-20, 2001 Niacin is an inexpensive drug useful in treating various forms of hyperlipidemia. Cardiac doses of niacin are effective in lowering serum triglyceride, low density lipoprotein, and lipoprotein-a levels and in elevating high density lipoprotein levels. Adverse reactions to niacin are varied and dose-dependent and range from annoying cutaneous flushing to hepatic toxicity. Patients advised to use the drug should be carefully screened and monitored. This paper reviews the pathologic and pharmacologic basis for niacin as an antilipemic agent. The biochemical and physiologic effects of the drug and its mechanisms of action are discussed. Emphasis is placed on the importance of aggressive management of serum lipids and the therapeutic uses of niacin. The use of niacin in primary and secondary prevention of heart disease is stressed. A patient education guide is included. T he current decline in coronary heart disease (CHD) in the U.S. may be attributed more to the prolongation of life among those with existing disease than to a decrease in the absolute number of deaths. Further decline in the CHD death rate will most likely depend upon successful secondary prevention of heart disease. Single or combined drug therapies together with maintenance of a healthy lifestyle are central to successful prevention of recurrent thrombotic events in coronary arteries. Ultimate success in decreasing the incidence of CHD will depend upon primary prevention of new onset of the disease.The combination of lifestyle changes and drug therapy has been shown to be effective in both primary and secondary prevention of CHD. One of the oldest drugs in the CHD armamentarium is nicotinic acid, commonly known as niacin. First used as a hyperlipidemic agent in 1955, niacin is a readily available, inexpensive mainstay of adjunctive therapy for prevention and treatment of CHD. This paper briefly reviews the pathology of hyperlipidemia and discusses the use of plain and immediate-release niacin as well as a new, extended-release form of niacin in secondary and primary prevention of CHD. Emphasis is placed on the clinical impact of the adverse effects of niacin as well as the role of the primary care provider in recommending its use.
Mortality over two centuries in familial hypercholesterolaemia
I love articles like these, especially with some much energy and money being thrown at genetics these days. This article follows one family for 200 years. The end result? Environment is much more important in risk of cardiovascular disease. As a society, we would be so much healthier if we could just focus a mere fraction of the money spent on disease awareness on prevention instead.
bmj.com Abstracts: Sijbrands et al. 322 (7293): 1019
Nut Consumption and Decreased Risk of Sudden Cardiac Death
Somewhere along the line nuts got a bad rap for being fattening and not good for us. Following the “as close to nature as possible” theory, nuts are really a very good food. This article adds to the increasing evidence that nuts are good for the cardiovascular system. Numerous studies already show lowering of cholesterol with nuts such as walnuts, pistachios and almonds. Nut and seed consumption should be a part of every healthy lifestyle.
Comparison of antioxidant effects of Concord grape juice flavonoids & alpha-tocopherol on markers of oxidative stress
While the findings that flavonoids in grape juice have potent antioxidant properties should not drop anyone’s jaw, this is a good time to remind everyone that, while we throw on our blinders and look only at cholesterol as the “bad guy” in CVD, the reality is that LDL cholesterol does not do any damage until the LDL itself gets damaged. The flavonoids in grape juice protect the LDL from becoming oxidized.
AJCN — Abstracts: O’Byrne et al. 76 (6): 1367
To Everything There Is a Season — Even Cholesterol
In 1968, The Zombies made it to #3 on the Billboard charts with a song that reminded listeners it was “the time of the season for loving.” It’s highly unlikely that any group is going to top the musical charts writing about the following subject, but a new study suggests that winter may not be the best “time of the season” when it comes to high cholesterol levels.
Researchers examined 517 healthy people over a 12-month period, documenting their cholesterol levels, diet, activity, exposure to light, and general behavior. While there were no significant changes in diet and calorie intake, cholesterol levels varied an average of 3.9 points per season in men, with a peak increase in December; in women, seasonal cholesterol levels varied as much as 5.4 points, peaking in January.
Overall, 22 percent more participants had total cholesterol levels of 240 or higher (considered high cholesterol) in the winter than in the summer. According to the researchers, the changes in blood cholesterol levels were due in large part to seasonal changes in blood plasma volume, which resulted from changes in temperature and/or physical activity levels between the winter and summer months.
Now that you know the affect of the seasons, have your cholesterol checked. And talk to your doctor of chiropractic about ways to change your diet or increase your activity levels year round. For more on general health and wellness click here.
Reference: Ockene IS, Chiriboga DE, Stanek EJ, et al. Seasonal variation in serum cholesterol levels. Archives of Internal Medicine, April 26, 2004;164:863-870.
Back to my favorite topic. The statin class of drugs to lower cholesterol and prevent heart attacks. Regular readers of the Rantings will know how I feel about this class of drugs.
To sum it up, they suck at preventing a first heart attack. Without going into detail here, you can read an overview by clicking on a previous blog article here.
For those of you who have been living in a cave, the statin class of drugs (think Lipitor, Crestor) was designed and promoted to lower cholesterol. By lowering cholesterol, we made a big jump in assuming that your risk of heart disease would also go down. After years of the drugs being given out like candy, we realized that the statins just weren’t that good at preventing heart attacks.
Then the studies came out that found that total cholesterol really wasn’t all that great of a risk factor for heart disease anyway. This left the statins in a huge vacuum.
Luckily, some creative researchers were able to create the idea that statins had “pleiotropic” effects–meaning that their benefit on heart disease was due to other factors besides cholesterol lowering. The race was on to determine what these additional benefits might be. Make sense, right? We have a drug making billions of dollars, so we should find out what they’re good for, right?
First came inflammation as measured by CRP. Trials (the biggest being the Jupiter trial) were done that looked at whether statins could lower inflammation as measured by CRP. And it seems like statins were able to lower CRP levels. Great, so now we have an expensive medication with a long list of side effects that lowers CRP. The problem? So does:
- Avoiding refined carbohydrates
- Losing weight lowers CRP
- Exercise lowers CRP
- Healthy fats lower CRP levels
- Increasing dietary fiber intake lowers CRP levels
- Increasing fruit and vegetable intake will lower CRP levels
Overall, when you compare lifestyle changes to statins in preventing heart disease and lowering CRP levels, there is no comparison.
So, scratch the possibility that we should look at statins and CRP levels and hang our prescription hat on this.
Which brings us to this particular study. Researchers looked at 26 patients with type 2 diabetes taking either simvastatin 40 mg (Zocor) or atorvastatin 10 mg (Lipitor). Here are the jaw dropping conclusions:
- Both lowered cholesterol levels about the same.
- Vitamin D levels were increased more in the atorvastatin group.
- While inflammation (CRP) and markers of oxidative stress (MDA) were lower, it was because of the higher vitamin D levels.
Atorvastatin increases vitamin D levels.
A long list of side effects, $200 / month and really sucks at preventing heart attacks. Why not just take vitamin D?