The Durk Pearson & Sandy Shaw®
Life Extension NewsTM
Volume 18 No. 7 • November 2015


Most Heart Attacks Are NON-FATAL, So the Reported Highly Protective Effect of Niacin

Against the Incidence of Non-Fatal Heart Attacks Is of Major Importance

In a paper (Keene, 2014) reports a meta-analysis of 117,411 patients, very interesting differences between the effects of niacin taken by patients NOT RECEIVING STATINS (this was before the statin era) and those who, later, were taking niacin and statins showed very statistically significant results that in those patients NOT taking statins, niacin was associated with a significant reduction in non-fatal heart attacks (myocardial infarction) (odds ratio was 0.69, 0.56 to 0.85, p=0.0004). However, in studies where statins were already being taken, niacin showed no significant effect on the incidence of non-fatal heart attacks, the researchers say. In the current era of widespread use of statins in dyslipidemia, substantial trials of these three agents [niacin, fibrates, or CETP inhibitors, all of which increase HDL levels] do not support this concept [that increasing HDL would generally reduce cardiovascular events].” Statins interfere with an important protective effect of niacin.

NON-FATAL MYOCARDIAL INFARCTIONS are the most COMMON type of heart attack, so reduction of these heart attacks is not at all unimportant, though the use of the descriptor “non-fatal” may cause people to underestimate the significance of these results.

Studies with statins and cholesterol-reducing agents (niacin or fibrates) have repeatedly shown that reductions in LDL cholesterol with these in combination with statins are able “to reduce cardiac events and all cause mortality in the setting of both secondary and primary prevention.” However, the increased protection against cardiovascular events expected by increased HDL has not been seen. See paragraph above. Hence, something in the interaction of statins with niacin and fibrates, where niacin and fibrates increase HDL cholesterol and which (when taken WITHOUT CONCURRENT INGESTION OF STATINS) reduces the risk of non-fatal myocardial infarctions, results in a loss of that protective effect of niacin or fibrates.

The studies with niacin were confounded by the fact that some of the patients were given aspirin or laropriprant to inhibit flushing. Laropriprant is thought to interfere with prostaglandin pathways which, as is explained in Sandy’s paper on prostaglandins and the niacin flush (Sandy Shaw, 2015), could be important and the authors of this paper(Keene, 2014) suggest that interference with prostaglandin pathways “could confound the effect of niacin.”

References

  • Keene et al. Effect on cardiovascular risk of high density lipoprotein targeted drug treatments niacin, fibrates, and CETP inhibitors: meta-analysis of randomised controlled trials including 117,411 patients. BMJ. 349:g4379 (2014) doi: 10.1136/bmj.g4379 (published 18 July 2014).
  • Sandy Shaw. Why the Niacin Flush May Be Surprisingly Beneficial to Your Health” in the July, August, and September 2015 issues of the web edition of the Life Enhancement magazine (www.life-enhancement.com).

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