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.