I Heard Taking Niacin For Cholesterol Was Dangerous Didnt They Stop A Drugs Trial
You are thinking about the US study called AIM-HIGH, , which was sponsored by the National Heart, Lung and Blood Institute .
In this study the researchers were looking to see whether raising HDL with a drug based on niacin, while at the same time lowering LDL with a statin drug could prevent more instances of heart disease than by just taking the statin by itself.
This is an ongoing study that started in 2006 and was due to finish in 2012, but it was halted eighteen months early.
Otc Supplements For The Management Of High Cholesterol
Emily M. Ambizas, PharmD, MPH, CGPAssociate Clinical ProfessorCollege of Pharmacy & Health SciencesQueens, New YorkClinical Specialist, Rite Aid PharmacyWhitestone, New York
US Pharm. 2017 42:8-11.
Cardiovascular disease remains the leading cause of mortality and morbidity in the United States, with coronary artery disease being the number-one cause of death.1 Dyslipidemia is a major contributor to the development of CAD and other forms of atherosclerosis individuals with high total cholesterol levels have about twice the risk for heart disease. Approximately 100 million adults in the U.S. have total cholesterol levels > 200 mg/dL , and almost 74 million have high levels of low-density lipoprotein cholesterol .2,3 Adults aged > 20 years should have their cholesterol measured at least once every 5 years.2
Niacin To Lower Cholesterol What Does The Future Hold
Without doubt more research is needed to make precise recommendations of niacin for cholesterol!
The correlation between niacin and higher levels of HDL is known, but the high dose required makes general usage difficult.
However, most studies conclude that niacin is an effective and inexpensive treatment that can improve the cholesterol-to-HDL ratio.
So at the moment, unless under medical supervision, high doses of niacin are not advised just keep eating a healthy balanced diet, take some exercise and make a few lifestyle changes the effects on your HDL levels will be just as good!
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More Research Is Needed
Large studies of niacin have limitations. For example, they studied niacin on top of statins, rather than alone, so its difficult to distinguish which effects may have been caused by which drug.
For now, doctors are using it cautiously and sparingly.
Statins are our first line therapy and now there are other safe and effective agents that also lower LDL, Dr. Cho says.
Its also important that people do not try to treat themselves with niacin supplements. If you have high cholesterol, talk with your doctor about the best way to get your cholesterol under control.
Is Niacin For Cholesterol Reduction A Good Idea Or Dangerous
Niacin, or vitamin B3, is too dangerous and should not be used routinely by people looking to control their cholesterol levels or prevent heart disease, doctors say. The warning comes following recent evidence showing the vitamin does not reduce heart attacks or strokes, and instead is linked to an increased risk of bleeding, diabetes and death.
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Niacin Its Hypolipidemic Effects And Cardiovascular Risk
Despite the substantial improvement in medical care for patients suffering from cardiovascular disease , this condition contributes to about 50% of deaths in Europe . Treatment of hyperlipoproteinemia, especially of elevated LDL-cholesterol and treatment of arterial hypertension, which decreases the risk of thrombotic events, are among the main therapeutic targets. It has been proved that intensive hypolipidemic treatment targeting recommended goals, of which statins are the most powerful LDL-C decreasing drug, significantly decreases cardiovascular risk . Moreover, statins favorably influence other parameters of lipoprotein metabolism, such as triacylglycerols and HDL-cholesterol . Nevertheless, even if the target goals of LDL-C are achieved, the risk of cardiovascular events during the following five years remains high ranging from about 6575% . This risk, known as residual cardiovascular risk, is probably particularly high in patients with manifest coronary heart disease or diabetes mellitus. Decrease of HDL-C, elevation of serum TAG, apolipoprotein B, small dense LDL particles, lipoprotein concentrations and some other factors significantly contribute to residual cardiovascular risk. In order to reduce residual risk, a combination of statins with fibrates, niacin or n3 polyunsaturated fatty acids is usually recommended .
Hdl Fats And Scavenger Receptors
One of the main reasons HDL levels tend to drop on the Pritikin Eating Plan is because the diet is low in saturated and monounsaturated fats. These fats suppress the production of scavenger receptors called B1.
At first glance, squelching these scavengers seems like a good thing. Thats because they latch onto HDL particles in the blood, extract their cholesterol, then release the emptied HDL particles back into circulation, which tends to lower HDL cholesterol levels.
But this process also allows the HDL particles to return more quickly to the artery wall and pick up more LDL bad cholesterol, and, of course, thats a very good thing.
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Frequently Asked Questions About Niacin
Is niacin safe to take while pregnant?
Its not known if niacin can cause harm to you or your unborn baby. If you are taking niacin for high cholesterol, then you should stop the medication if you become pregnant and contact your provider. If you are taking niacin for high triglycerides and you become pregnant, discuss the benefits and risks of continuing the medication with your provider. Your healthcare provider will help you decide if you should continue therapy with niacin or switch to an alternative.
Whats the difference between the immediate-release , extended-release , and sustained-release forms of niacin?
Should I take niacin in the morning or at night?
In general, the immediate-release form of niacin should be taken after your evening meal and the extended-release form should be taken at bedtime after a low-fat snack. Taking it in the morning or on an empty stomach might cause you to experience more side effects such as flushing and stomach upset.
Do I need to change my diet while taking niacin?
Niacin should be taken together with a heart-healthy diet. A heart healthy diet is lowering your intake of saturated and trans fats, adding more vegetables, fruits, fish, and whole grains to your diet. A healthy diet paired with regular physical activity will help you achieve your goals of bringing your cholesterol numbers down. Ask your healthcare provider for more information about how diet and exercise can help you lower your cholesterol.
Niacin And Other B Vitamins In Cardiovascular Risk
Niacin is used in a variety of multivitamin supplements together with other vitamins of class B, such as thiamine , riboflavin , and pyridoxine . According to the National Institutes of Health , the U.S. Recommended Daily Allowance for adults ranges between 16 and 18 mg daily . Daily intake of niacin via multivitamin supplements maximally reaches tens of milligrams, which is far below the pharmacologically active hypolipidemic dosage . The main sources of dietary niacin are meat, fish, and nuts . Both experimental and clinical data provide evidence for the importance of B vitamins in the pathophysiology of metabolic syndrome and in the prevention of cardiovascular diseases. Recent studies have shown that low levels of thiamine, niacin, and pyridoxine are associated with increased insulin resistance, metabolic syndrome, diabetes, and cardiovascular disease .
Furthermore, pyridoxine influences the metabolism of fatty acids. The study on volunteers with marginal nutritional deficiency of vitamin B6 showed decreased plasma concentrations of polyunsaturated fatty acids of the n6 and n3 families, whereas the levels of TC, LDL-C, HDL-C, and TAG did not change . Altered synthesis of unsaturated, particularly n6 and n3 PUFA, was proved in cultured human hepatoma cells under the condition of vitamin B-6 restriction . These changes could participate in mechanisms by which vitamin B-6 inadequacy influences cardiovascular risk .
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Ask The Doctors Does Niacin Help Lower Cholesterol
Dear Doctor: Ive been taking niacin for years to lower my cholesterol. Do you think it really helps?
First, lets look at niacin and its role in the body. Niacin is a B vitamin that the body needs to create the compounds NAD and NADP , both of which are crucial to cellular function.
A shortage of niacin, also known as vitamin B3, can lead to diarrhea, nausea, vomiting, rash and, when severe, neurologic conditions that manifest as confusion and dementia. Fortunately, because of our varied and plentiful diet, not to mention supplementation of foods, niacin deficiency is rare in this country. Foods high in niacin include meat, mushrooms and potatoes the recommended daily allowance is 15 milligrams.
As for cholesterol, some research does support niacins ability to improve cholesterol levels. In 1955, in one of the earliest studies of niacin, researchers found that doses of 1,000 to 3,000 milligrams significantly lowered total cholesterol levels in men. Niacin has also been found to lower levels of LDL, the so-called bad cholesterol, while raising levels of HDL, the so-called good cholesterol.
Such research suggests that niacin would be a great therapy to decrease the risk of heart attacks and strokes. The science, however, is less than conclusive.
Overall, niacin is certainly better than not addressing high cholesterol levels, especially if its been working for you, which your doctor should be able to tell you.
What Foods Should I Eat What Foods Should I Avoid
Maintaining a healthy diet can help lower your cholesterol. Recommended foods include fruits and vegetables whole grain foods fat-free, 1%, or low-fat milk products poultry without skin and lean meats fatty fish such as salmon, trout, albacore tuna, and sardines and unsalted nuts, seeds, and legumes.
A diet high in cholesterol, saturated fats, and trans fats should be avoided. This includes high-sodium foods sweetened or sugary beverages red, fatty, or processed meats full-fat dairy products baked goods with saturated and trans fats solid fats or fried foods and hydrogenated and saturated oils.
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Which Niacin Medicine Is Right For You
There are different brands of niacin medicines. Most of these also come in a less expensive, generic form.
Niacin may be prescribed along with other medicines, such as a statin, to help lower cholesterol. Combination tablets that include nicotinic acid plus other medicines are also available.
Niacin is also sold over-the-counter as a supplement. You should not take OTC niacin to help lower cholesterol. Doing so could have serious side effects.
Lowering Cholesterol With Niacin Or Nicotinic Acid
Last Editorial Review: 12/30/2004niacin
Doctor’s Response:
There are two types of nicotinic acid: immediate release and timed release. Most experts recommend starting with the immediate-release form discuss with your doctor which type is best for you.
Nicotinic acid is inexpensive and widely accessible to patients without a prescription but must not be used for cholesterol lowering without the monitoring of a physician because of the potential side effects.
All patients taking nicotinic acid to lower serum cholesterol should be closely monitored by their doctor to avoid complications from this medication. Self-medication with nicotinic acid should definitely be avoided because of the possibility of missing a serious side effect if not under a doctor’s care.
Patients on nicotinic acid are usually started on low daily doses and gradually increased to an average daily dose of 1.5 to 3 grams per day.
Nicotinic acid reduces LDL-cholesterol levels by 10 to 20 percent, reduces triglycerides by 20 to 50 percent, and raises HDL-cholesterol by 15 to 35 percent.
Three other major adverse effects include liver problems, gout, and high blood sugar. Risk of these three complications increases as the dose of nicotinic acid is increased. Your doctor will probably not prescribe this medicine for you if you have diabetes, because of the effect on your blood sugar.
Thank you for your question.
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Cholesterol Control: Statins Vs Niacin
Overview
Cholesterol often gets a bad rap. While there is such a thing as bad cholesterol, good cholesterol is actually important for heart health. The key, as with all aspects of health, is balance.
Another name for bad cholesterol is low-density lipoprotein . Good cholesterol is formally known as high-density lipoprotein .
When your LDL cholesterol level is high, you might need medical treatment in the form of statins. However, due to the possible side effects, you may also be wondering about alternative treatments, such as niacin .
There are a variety of causes that can lead to high cholesterol. Some of these are out of our control and determined by genetics, and some are lifestyle choices that we can change.
Different factors that can cause or increase your risk of high cholesterol include:
- having a family history of high cholesterol
- smoking
- eating an unhealthy diet high in unsaturated fats and cholesterol
- lack of exercise
- having other illnesses, such as diabetes
- taking certain medications, including steroids and progestin
- being obese
- age
- gender
Don’t Take Niacin For Heart Health Docs Warn
ByBahar Gholipour16 July 2014
Niacin, or vitamin B3, is too dangerous and should not be used routinely by people looking to control their cholesterol levels or prevent heart disease, doctors say. The warning comes following recent evidence showing the vitamin does not reduce heart attacks or strokes, and instead is linked to an increased risk of bleeding, diabetes and death.
Niacin has long been used to increase people’s levels of high-density lipoprotein , or the “good” cholesterol, and has been a major focus of research into heart disease prevention for several decades. However, clinical trials have not shown that taking niacin in any form actually prevents heart problems. Considering the alarming side effects of niacin, researchers now say the vitamin shouldn’t even be prescribed anymore.
“There might be one excess death for every 200 people we put on niacin,” said Dr. Donald Lloyd-Jones, a cardiologist and chair of preventive medicine at Northwestern University Feinberg School of Medicine. “With that kind of signal, this is an unacceptable therapy for the vast majority of patients.”
The study also found some unexpected and serious side effects. People who took niacin were more likely than people taking a placebo to experience liver problems, infections and bleeding in various body areas including the stomach, intestines and brain.
The popular rise of niacin
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Other Natural Ways To Lower Cholesterol Sans Meds
If you want to take niacin for cholesterol, it will be one of the best ways to lower cholesterol. However, there are other ways to lower cholesterol than medications and the supplements above, and you will find a whole list of other foods and supplements that can help you fight your cholesterol below:
These few natural supplements can help you to lower your cholesterol levels without the need for medications.
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High Doses To Lower Cholesterol
Aside from treating niacin deficiency, high doses of niacin typically 500 milligrams or higher have been used to treat high cholesterol. According to MedlinePlus, doses this high are typically sold as prescription products. Because very high doses are required for treating high cholesterol, dietary supplements which typically come in strengths of 250 milligrams or less are not appropriate for this use.
One study published in the journal Archives of Internal Medicine tested high doses of niacin, combined with a prescription cholesterol-lowering drug. This study, which started at a daily 500-milligram dose and eventually increased to 2,500 milligrams per day, found that niacin, combined with one type of statin drug, was able to improve four types of cholesterol commonly associated with atherosclerosis.
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Drug Raised Hdl As Expected
The study, called the AIM-HIGH trial, enrolled 3,414 volunteers in the United States and Canada who were taking a statin to keep their LDL cholesterol low. More than half had suffered a heart attack before entering the trial.
All volunteers were given Zocor, and 515 participants were given a second LDL cholesterol-lowering drug, Mercks Zetia, or ezetimibe, to make sure their LDL stayed in the target range of 40 to 80 milligrams per deciliter, which are very low levels.
Researchers said the drug performed as expected, raising HDL by about 28 percent and lowering triglycerides by about 25 percent, in keeping with other studies.
Late last month, an independent panel looked at the interim results of the study and concluded that high-dose niacin offered no benefits beyond statins alone in reducing heart complications, prompting the decision to end the study early.
There was also a slightly higher rate of strokes among patients who took niacin, but the overall rate of strokes in both groups was low.
Abbott, which reported Niaspan sales rose 8.4 percent to $927 million last year, said the relevance of the findings outside the type of patients in the study is currently unknown and it would be premature to extrapolate these results to a broader patient population at this time.
Wells Fargo Securities analyst Larry Biegelsen said the surprise findings could cut Niaspan sales by 20 to 30 percent.
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