LifeCare Chiropractic

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HDL

Extended-Release Niacin Safe for Diabetics W/ Hypercholesterolemia – (04-23-01)

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Extended-Release Niacin Safe for Diabetics W/ Hypercholesterolemia

There has been some concern in the past with regards to the safety of using niacin with diabetics. This study evaluated a 1 and 1.5 gram dose of extended release niacin in diabetics. These dosages of typically much lower than has been used in other studies (typically 2-3 grams are used); however, these patients were already on additional cholesterol-lowering medications and this may be the reason for the lower dose used. Overall, the results were favorable, with the 1.5 gram dose having some effect on glycemic control. Both dosages were very effective in increasing HDL levels.

50th Annual Scientific Session of the American College of Cardiology Diabetics with poorly controlled cholesterol levels despite statin therapy can be safely given extended-release niacin. The combination significantly improves the lipid profile without adversely affecting glycemic control, Texas researchers reported . In the past, niacin has been shown to worsen glycemic control in diabetics, Dr. Gloria L. Vega of the University of Texas Southwestern Medical Center in Dallas said, even though niacin corrects the lipid abnormalities typically seen in diabetes. In her presentation to conference attendees, Dr. Vega described how she and her colleagues tested extended-release niacin (Niaspan, Kos Pharmaceuticals, Miami) in 148 diabetics with abnormal lipid profiles, many on statin therapy, in a 16-week trial. The researchers compared the effects of 1 gm and 1.5 gm extended-release niacin with placebo. Dr. Vega reported that 1 gm extended-release niacin increased high-density lipoprotein cholesterol levels 19% and 1.5 gm increased them 24%, while placebo had no significant effect. Levels of low-density lipoprotein cholesterol did not change significantly with either placebo or 1 gm niacin, while they dropped 8% with the 1.5 gm dose. Triglyceride levels dropped 24% and 29% for patients on 1 gm and 1.5 gm extended-release niacin, respectively. Fasting blood glucose and hemoglobin A1c levels did not change during the study in the placebo and 1 gm arms of the study, but patients on 1.5 gm niacin had a worsening of glycemic control. “We are very excited about this study,” Dr. Vega told Reuters Health. “Extended-release niacin can be incorporated into the treatment regimen of diabetics….It can be used with statin therapy or triglyceride-lowering drugs….There was no increase in liver enzymes and no increased weakness” during the study period, she added. “Certainly you are not going to take a patient with poor glycemic control and try this,” Dr. Vega said. “But most physicians are not aware that niacin can effectively increase HDL….Niacin has a bad reputation in terms of glycemic control, but you can control that with drugs rather than discontinue the niacin,” she asserted.

Very-low–dose niacin on HDL in patients on long-term statin therapy – (06-10-02)

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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?

Read entire article here

METABOLIC SYNDROME ASSOCIATED WITH ELEVATED OXIDATIVE STRESS – (10-20-04)

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Metabolic Syndrome Is Associated with Elevated Oxidative Stress and Dysfunctional Dense HDL Particles Displaying Impaired Antioxidative Activity

For those not yet aware, HDL actually has several subtypes, the subtype HDL2 seeming to be the most protective. These subtypes have antioxidant and protective abilities, but, in insulin resistant patients, they lose a large percentage of their protective abilities. So, take the poor woman above who had her ovaries drilled. I now believe that it should be considered malpractice. The OB drills a patient’s ovaries, an unnecessary procedure, and remains totally oblivious to the fact that this patient has a major metabolic abnormality that is wreaking havoc on the rest of her body.

Metabolic Syndrome Is Associated with Elevated Oxidative Stress and Dysfunctional Dense High-Density Lipoprotein Particles Displaying Impaired Antioxidative Activity.

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NORMAL FASTING PLASMA GLUCOSE LEVELS – (11-07-05)

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Normal Fasting Plasma Glucose Levels and Type 2 Diabetes in Young Men

Remember that progression to diabetes is a continuum–a patient is not normal on Thurs and then diabetic on Friday when their labs finally tip over to abnormal. I can’t tell you how many patients come through my office with elevated triglycerides, low HDL, elevated LDL, hypertension, abdominal obesity and strong family history of diabetes and CVD, and tell me that they’re not diabetic because their family doc checked “that.” If physicians learned what to look for, we could be catching these patients literally DECADES before they get a diagnosis of diabetes or have their first heart attack, and starting them on a lifestyle management program. But alas, the status quo prevails…

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MAINTENANCE OF HIGH LDL CHOLESTEROL – (01-09-06)

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Maintenance of the LDL Cholesterol: HDL Cholesterol Ratio in an Elderly Population Given a Dietary Cholesterol Challenge

While Dr. Ornish may disagree (and actually-his program was much, much more than just a low-cholesterol diet), I’ve never been all that concerned with dietary cholesterol. It’s not as simple as more dietary cholesterol = higher blood cholesterol. In many cases, it’s endogenous production driving by high insulin levels that’s more imp’t. But physicians still demonize high cholesterol foods that are good for us. Avocados. Eggs (especially the high omega-3 type).

This study supports the fact that dietary cholesterol is not as closely tied to cardiovascular risk as many would think.

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NIACIN USED TO PREDICT HEART DISEASE RISK – (12-27-06)

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Effects of Extended-Release Niacin on Lipoprotein Particle Size, Distribution, and Inflammatory Markers in Patients With Coronary Artery Disease

While niacin has been known for a long time to be one of the few compounds used in a pharmacologic manner (soy, flax and exercise does as well–but these aren’t use in a pharmacologic approach), the beneficial subclass changes in the specific lipids in this study were quite surprising.  Recall that we have further delved into the HDL and LDL molecules and found that these particles can be furthered subdivided, and that these subclasses can have even more dramatic abilities to predict heart disease risk.

Niacin in this study was found to raise the “best of the best” as large particle HDL by 32% and reduced the small particle LDL by 12% while also raising the large particle LDL by 82%.  Taken together, these changes would suggest that niacin has a much greater ability to lower CVD risk than many other molecules available.

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ERRORS FROM TC/HDL C RATIO RISKS VASCULAR DISEASE – (07-17-06)

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Errors that result from using the TC/HDL C ratio rather than the apoB/apoA-I ratio to identify the lipoprotein-related risk of vascular disease

Wow. Sometimes we really hit articles that remind us how far we can fall behind in the research. Most physicians are still blissfully making clinical decisions based entirely on total cholesterol. Some even take HDL into account. Smaller still are the physicians recognizing the risk that triglycerides/HDL ratio play. So, while most physicians are decades behind using tri/HDL ratios, research is finding that apoB/apo A-1 ratios are much, much stronger at predicting CVD risk. Just when mainstream medicine might have been catching up…

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JUST CHECKING CHOLESTEROL DOES NOT GIVE A GOOD PICTURE OF HEART DISEASE – (02-21-05)

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Insulin resistance, adiposity influence lipoprotein size, subclass concentrations

This study really demonstrates how behind the research most clinicians are.  Just checking cholesterol really does not give us a good picture of where the patient is as far as their risk for heart disease.

This study evaluated subclasses of LDL (small, intermediate, large), VLDL (very low density lipoprotein) and HDL.  Worsening insulin resistance did not affect LDL levels.  However, strong changes were seen in the subclasses–decrease in the large LDL offset increases in the other sizes of LDL.

So, if one just looks at straight LDL, you just missed the fact that the real picture is one of worsening risk (larger LDL and larger HDL particles are generally considered protective).  Subfractioning of the cholesterol molecules is looking more and more like a good idea…

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