Central  South  Dakota  Medical News
The Clinical View
by Phillip Hoffsten
28 July 2004

How Does Niacin Affect Your Cholesterol?

     But there are still a substantial number of heart attacks that occur in people whose cholesterols are normal.  We now have learned that a normal cholesterol is really less than 180 mg% and a normal LDL (bad cholesterol) is really 70 mg% or less.  Be that as it may, there still seem to be abnormalities in the kind of cholesterol that are not completely corrected by the “statin” family of drugs.

     Once the total cholesterol is down in an appropriate range, there is still an abnormality that can occur called “pattern B dyslipidemia”.  This is characterized by a very high triglyceride level and correspondingly low HDL cholesterol (good cholesterol).  This pattern B predisposes to heart attacks and strokes in a manner similar to the way high blood cholesterols do.  The “statin” family of cholesterol drugs doesn’t fix a pattern B.

     To understand the problem better, one has to think about what happens to the calories that you eat during the day but do not use at that time.  Those calories from sugars and carbohydrates are taken to the liver where they are turned into triglycerides.  Triglycerides are then carried from the liver out to the fat deposits on the hips, legs and the tummy where they get deposited.  Triglycerides are a major source of energy for the muscle but people who aren’t exercising and eat more than they need don’t burn enough triglycerides to avoid the fat deposits.  So pattern B dyslipidemia is basically a problem of overnutrition.  The best way to fix this is to cut down on calorie intake.  That has been described in a previous column as the best way to correct the problem but as everyone can see from our national epidemic of overweight, cutting down calories just doesn’t seem to be happening.

     Many years ago it was discovered accidentally that large doses of niacin will reduce all lipid abnormalities.  Specifically, it reduces the total cholesterol, the bad cholesterol and triglyceride levels and slightly raises the good cholesterol level.  Over the years, there has never been a question of the effectiveness of niacin to achieve this and now there is good data to show that long term use of niacin reduces heart attacks and strokes presumably by favorably affecting the person’s lipid profile.

     The problem with niacin is the symptomatic side effects. There are three types of niacin available on the market.  One of these is called immediate release; it is simply pure niacin that gets into the blood stream as soon as it gets into the stomach.  This results in a sensation of hot flashes and itching.  Those symptoms can be very disconcerting and very few people use immediate release niacin.

     Because of these side effects, a product called Slo-niacin was introduced into the market several years ago. This prevented the rapid ingestion of the niacin and cut back the side effects somewhat.  However its effectiveness is marginal.  Side effects did still occur and this product has never really graduated into the mainline of anti-cholesterol treatment.

     Several years ago, a pharmaceutical company introduced a product called Niaspan which has dramatically cut down on the side effects.  It is taken at night before the person goes to bed along with an aspirin.  The doses are started small and over the course of several months, it is slowly increased as tolerance to the medication develops.  In my experience, more than 80% of the people that use this method are able to tolerate the drug comfortably and have a significant benefit in lowering their total triglycerides and raising the HDL.

     In the past, there were reports that niacin made diabetes worse but the use of Niaspan has not been associated with that problem at all.  In addition, there were reports of liver abnormalities that developed with the immediate release niacin and that problem has not been seen with the use of Niaspan.  Combinations of a “statin” drug and Niaspan together have been used and seem to be effective and safe.  This is in contrast to the use of “statin” drugs with a product called gemfibrozil (Lopid) which can cause muscle damage in patients using a “statin” drug.

     In summary, niacin can be a very effective anticholesterol medication used either alone or in combination with a “statin” product.  Clearly the statin product is more effective in lowering total cholesterol and LDL but does not affect pattern B dyslipidemia.  Niacin clearly, effectively treats pattern B dyslipidemia and if that is the basic problem, it would be the favored drug to use.  The healthcare professionals at your local clinic are aware of these considerations and can help pick the right medication to lower your cholesterol and prevent heart attacks and strokes.