A recent study released in The New England Journal of Medicine reveals troubling news for patients taking niacin, a drug prescribed to patients with high cholesterol. Despite lowering LDL and triglyceride levels, and raising HDL levels, niacin did not improve overall vascular health and did not reduce adverse vascular events (such as myocardial infarction, cardiac death, stroke, or cardiac stenting) in patients already on statin therapy.
The efficacy of niacin has been in question for some time. In the 1960s, niacin first became a common medication in the United States. At that time, niacin was the only drug that affected cholesterol levels, and it was the only drug with limited evidence supporting its use for improving vascular health. However, newer drugs for the prevention of cardiovascular disease have been formulated, most notably, the statins, first popularized in the 1980s.
With the proven efficacy and the safety of statins, the question has become whether niacin in addition to statins would further reduce vascular events. The results of the recent trial in the New England Journal of Medicine suggest that adding niacin to a background of statin is of no benefit.
In addition, consumption of high doses of niacin was found to produce adverse side effects, including infections and bleeding. Diabetic complications were particularly troubling: Among patients who had diabetes at the start of the trial, serious complications related to diabetes occurred in 11.1% of patients in the treatment group versus 7.5% of patients in the control group, a 55% increase. Among patients who did not have diabetes at the start of the trial, there was a 32% increase in the diagnosis of diabetes in the treatment group (5.7% versus 4.3%).
These findings are leading doctors to prescribe alternative medications. Doctors who specialize in the prevention of diseases associated with cholesterol buildup suggest that niacin should be a drug of last resort – for patients unable to tolerate statins. If you tolerate statins, there is unlikely to be significant benefit for adding niacin to your medication regimen. If you are currently taking niacin with no adverse effects, speak with your doctor about the necessity of continuing this medication.
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