Niacin has had it tough lately. Primary care docs and even cardiologists are telling patients to stop niacin. Here’s what we think.
The AIM HIGH trial in 2011 and just recently the HPS2-THRIVE trial both found that niacin in combination with statin did not improve cholesterol parameters. The AIM HIGH trial found more strokes in the niacin treated patients, but it was not statistically significant. Both studies looked at a high risk population with low HDL “good cholesterol” and very low LDL “bad cholesterol”, 71 mg/dl in AIM HIGH and 63 mg/dl in HPS2-THRIVE. Most of the participants were already using statins. They wanted to see if raising the HDL levels would lower the risk of cardiovascular events. It did not.
We think this says more about the study population than it does about niacin. High risk patients have cardiovascular events and raising the HDL may not have been enough to offset them. Plus, the studies looked at HDL alone, not HDL particle type. Cholesterol is particles floating in your blood. There are five kinds of HDL particles, but only one lowers cardiovascular disease risk. This high risk population may have had a predominance of the wrong kind of HDL particles.
The study population is atypical in that they already met the LDL treatment targets with statins. There are plenty of good studies showing the cardiovascular benefits of niacin alone compared to a placebo, and in patients with much higher LDL cholesterol levels, which is more typical.
We are flummoxed by the use of Laropiprant in HPS2-THRIVE trial. The drug has been taken off the market in the European Union and has never been available in the United States. Laropiprant reduces the often troublesome flush associated with niacin. We know that flush-free niacin does not benefit lipids. We can’t find much information on this drug, but we wonder if reducing the flushing reduced the benefits of niacin.
So should you continue to use niacin? Absolutely yes, we say! Here at HealthSpan we have ways to improve your cardiovascular risk profile without the use of statins. We use state of the art cholesterol particle screening as well as other risk markers to get the clearest picture of your risk status. Learn more about Beyond Cholesterol, our holistic heart disease prevention program.