Niacin vs statins for lowering cholesterol For decades now we’ve been told to take cholesterol-lowering statin drugs despite the fact that they are remarkably ineffective unless you are a man and have already had a heart attack. Just how poor the evidence is and how little effort has been made to discover the number of people troubled by side-effects was highlighted in a review of statins by the respected Cochrane Collaboration at the beginning of 2010. It analysed trials involving 34,272 people who hadn't had a heart attack and found little evidence that taking a statin would protect people from having a first heart attack unless their risk was classified as high. These are drugs given to about four and a half million healthy people in the UK.
A study in the Lancet five years ago found that even though the drugs prevented a few heart attacks, none of the patients lived any longer as a result. That’s bad enough – if you are told this pill will cut your risk of a heart attack, you assume that it will also make you live longer. But it gets worse. Men over 69 didn’t benefit from taking statins at all. They didn’t live longer and didn’t have fewer heart attacks, and women of any age didn’t benefit either. That’s right, not at all. Niacin (vitamin B3) is available on prescription in high doses of 500mg. It is by far the most effective cholesterol-lowering substance because it not only lowers the ‘bad’ LDL, it also lowers triglycerides and lipoprotein(a) – all by about a quarter, and it raises the good HDL. No drug does all this. It also reverses atherosclerosis (arterial thickening) and risk of cardiovascular events. Quite a few studies have proven its benefit when given with statins, versus statins alone, although one recent trial failed to show a clinical benefit.
The best review on niacin, published in Pharmacology and Therapeutics last year, is by Dr John Chapman and colleagues who concludes “available clinical evidence demonstrates that niacin-based therapies effected marked improvements across all components of the atherogenic lipid profile (HDL, LDL, triglycerides), together with a regression of atherosclerosis as evidenced by change in coronary artery stenosis and luminal diameter, and reduction in the progression of intima-media thickening; such changes translated into a reduction in clinical events.” Niacin is usually given in a dose of 1,000mg a day (500mg twice a day) although slightly better results are achieved with 2,000mg a day. Most trials have been on a slow-release form called Niaspan. Niacin also works but makes you blush for up to 30 minutes. Niacinamide does not. Inositol hexanicotinate, the non-blush form, should work but there’s no definitive trial on it.
Lipoprotein(a) and vitamin C – Linus Pauling’s legacy
Working with Matthias Rath, Dr Linus Pauling’s last discovery was that lipoprotein(a) is an independent predictor of heart disease. They proposed that when the arteries become damaged, the body makes more of a protein called apoprotein(a), which attracts fat and becomes lipoprotein(a), which then sticks to damaged areas in the arteries –effectively repairing the damage. They proposed that a lack of vitamin C was one cause of increasing lipoprotein(a), called Lp(a) for short, and showed that giving high dose vitamin C (eg six grams a day) together with the amino acid lysine (three grams a day) could lower Lp(a) and heart disease risk. Lipoprotein(a) is certainly getting a lot of interest at the moment as a key risk factor. For example, a recent study in the journal Thrombosis Research, involving 955 people who had coronary artery disease (many of whom had had a heart attack) found that Lp(a) and homocysteine predicted risk in women, but not significantly in men. Having both an elevated homocysteine and Lp(a) “conferred a significant, 3.6-fold risk of coronary artery disease in females and even higher (11-fold) risk in young females, which suggested an interactive effect” say the authors. Lp(a) is considered to be an independent and causal risk factor for heart disease and the most effective way to lower it, by about a third, is with high-dose niacin, according to a study published in the European Heart Journal.
High dose vitamin C also makes a lot of sense not only because it lowers Lp(a) and cholesterol, but also because it is an anti-inflammatory. A recent study in Stroke, of almost 60,000 people in Japan, reports that vitamin C intake is strongly associated with a reduced risk of heart disease, especially in women, cutting risk by a third.
Homocysteine – the single best predictor in older people
Having a high blood level of homocysteine is a risk factor for heart disease quite independent of cholesterol. In fact, studies have found that homocysteine is a better predictor of cardiovascular problems than either cholesterol, blood pressure or smoking. Among elderly people cholesterol is a very poor predictor of cardiovascular disease death, as is a widely used index of conventional risk factors called the Framingham risk score. According to a study published in the British Medical Journal the best predictor by far is your homocysteine – a level above 13 ......
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