From
Prevention:
I'd like to share a secret with you--one whose importance cannot be overstated. With this knowledge, you may be able to significantly decrease the chance that you or a loved one will ever die of heart disease.
The "secret" concerns a B vitamin called
niacin. When niacin is taken with a statin, the combination reduces heart attack risk by up to 90%, according to a University of Washington study. Medical research has never been more supportive of this treatment, yet very few people know about it, and many primary care doctors don't prescribe it. A few of its impressive benefits:
It raises "good" HDL cholesterol and lowers triglycerides.
It enlarges the smallest, densest, most dangerous particles so they're less likely to damage arteries (although it doesn't lower "bad" LDL cholesterol as significantly as statins do).
And it brings down levels of another harmful component of blood called lipoprotein(a), which is resistant to the benefits of statins, diet, and exercise.
But here's the catch: You can't get enough of these vitamins naturally in your diet to achieve those results. The RDA for niacin is 14 mg for women and 16 mg for men, but to gain the benefit of lowering the chance for heart disease, you need 500 to 2,000 mg. At this dosage, many patients commonly experience flushing--the skin reddens, warms, and sometimes itches. Although this side effect subsides within an hour, the experience can be unpleasant. This is why some doctors hesitate to prescribe niacin.
These symptoms can be minimized if the niacin is taken with aspirin, antihistamines, or a meal. In fact, flushing is a positive sign that blood vessels are dilating in response to the niacin, new research concludes, and patients who flush ultimately raise their HDLs and lower their triglycerides more than those who don't flush. Once patients understand this, they're less likely to be intimidated by the reaction and will continue with treatment.
But before you embrace niacin wholesale, be aware of these considerations:
Make sure you need it. Generally, you're a good candidate for niacin therapy if you're already taking a statin but your triglycerides are above 150 mg/dL and your HDLs are below 45 (for men) and 50 (for women.) Two prescription forms of niacin are available: Niaspan and Niacor. I've prescribed the former for years, and with a little education, patients tolerate it well.
Niacin alone confers no benefit. It is effective only when paired with a statin; it generally isn't prescribed on its own. Soon we'll probably see drugs that combine niacin and a statin in one pill.
Be careful if you have prediabetes or diabetes. Niacin can raise levels of blood glucose. This effect is generally mild, though, and doesn't outweigh its heart-protecting benefits. Nonetheless, consult with your doctor if you begin taking it.