Niacin: An Old Cholesterol Remedy Is New Again

Pfizer Inc., the pharmaceutical giant, recently halted late-stage trials of a cholesterol drug called torcetrapib after investigators discovered that it increased heart problems - and death rates - in the test population. The drug was to have been a blockbuster heralding the transformation of cardiovascular care primarily by increasing HDL, or good cholesterol. For patients now at high risk of heart attack or stroke, the news is not all bad. An effective HDL booster already exists. It is niacin, the ordinary B vitamin. In its therapeutic form, nicotinic acid, niacin can increase HDL as much as 35 percent when taken in high doses, usually about 2,000 milligrams per day. It also lowers LDL, though not as sharply as statins do, and it has been shown to reduce serum levels of artery-clogging triglycerides as much as 50 percent. Despite its effectiveness, niacin has been the ugly duckling of heart medications, an old remedy that few scientists cared to examine.

“There’s a great unfilled need for something that raises HDL,” said Dr. Steven E. Nissen, a cardiologist at the Cleveland Clinic and president of the American College of Cardiology. “Right now, in the wake of the failure of torcetrapib, niacin is really it. Nothing else available is that effective.” In 1975, long before statins, a landmark study of 8,341 men who had suffered heart attacks found that niacin was the only treatment among five tested that prevented second heart attacks. Compared with men on placebos, those on niacin had a 26 percent reduction in heart attacks and a 27 percent reduction in strokes. Fifteen years later, the mortality rate among the men on niacin was 11 percent lower than among those who had received placebos. “Here you have a drug that was about as effective as the early statins, and it just never caught on,” said Dr. B. Greg Brown, professor of medicine at the University of Washington in Seattle. “It’s a mystery to me. But if you’re a drug company, I guess you can’t make money on a vitamin.”

Courtesy of NY Times

Bonnie - Bingo! Dr. Brown hit it right on the head. Unlike a vitamin, creating a new drug like torcetrapib would have brought Pfizer billions.

Niacin is extremely effective in raising HDL. In fact, Dr. Stephen Devries, the preventive cardiologist that I work with, has always been an ardent supporter of niacin. It us up to doctors to rediscover niacin again.

When taking niacin in high doses, it must always be under a doctor's supervision. Niacin can in rare instances, can cause liver damage and can impair the body’s use of glucose. A more frequent side effect is flushing. It becomes less pronounced with time, and often it can be avoided by taking the pills before bed with a bit of food. Doctors also recommend starting with small doses and working up to larger ones. Extended-release formulations of the vitamin, taken once daily, are now available by prescription.