Adding Niacin to Statin Drugs Shown to Slow Artery Disease; Vitamin Also Known for Effect on HDL

Adding Niacin to statin drugs shown to slow artery disease

Vitamin also known for effect on HDL

New Orleans — Adding a high dose of niacin to a statin drug slowed the progression of artery disease in people with known heart disease, according to a new study that may prompt more doctors to prescribe the B vitamin.

It has been known for years that niacin (vitamin B3) can increase levels of HDL cholesterol, the good kind. However, until Wednesday no studies have documented an effect on actual artery disease.

To measure that, doctors at Walter Reed Army Medical Center used ultrasound imaging of the carotid artery as a surrogate for coronary artery disease, a method that has proven accurate in the past.

The researchers then took a group of 167 patients with known heart disease and put them on a cholesterol-lowering statin or a statin and a 1,000-milligram, extended-release niacin pill.

After one year, those taking niacin had a 21% increase in their HDL cholesterol, up from an average of 39 milligrams per deciliter to 47 mg/dl. HDL was unchanged in the statin-only group.

More importantly, ultrasound showed the niacin group had no change in the thickness of their carotid arteries, compared with an increase in the statin group. The improvement was especially significant in patients who did not have insulin problems.

Lead author Allen Taylor, director of cardiovascular research at Walter Reed, said the study was the first to document a benefit in artery disease when comparing statins alone with a statin and niacin.

“Patients on statins can still have progression of plaque buildup,” Taylor said. “This shows you can go beyond statins.”

Major guidelines still do not recommend niacin for treatment or prevention of heart disease.

However, some cardiologists in specialized clinics have been prescribing it for their patients with low HDL cholesterol, said Daniel Rader, director of preventive cardiology at the University of Pennsylvania.

“We do it based on faith and that low HDL is a bad thing,” said Rader, who was not associated with the study.

The new study should prompt more doctors to prescribe niacin, he said.

Rader noted that some doctors are reluctant to put patients on niacin because of side effects, primarily flushing or hot flashes.

Large trials that look at whether niacin actually can reduce heart attacks and strokes are still needed, said Sidney Smith, a professor of medicine and director of the Center for Cardiovascular Science in Medicine at the University of North Carolina, Chapel Hill.

“It is a very nice study,” said Smith, who was not associated with the trial. “The results are going in the way we would hope they would.”

The trial was funded by Kos Pharmaceuticals Inc., maker of Niaspan, the prescription-only, extended-release niacin pill used in the study.