Lisa Says: I came across this interesting study published in the New England Journal of Medicine about the use of Niacin (vitamin B3) vs. Zetia in addressing cholesterol imbalance. If I had this issue, it would be great information to discuss with my health care provider to make a more informed decision.
November 16, 2009 12:37 PM Sacramento Nutrition Examiner Anne Hart
Latest studies have reviewed the data and the effects, and found that the simplest solution, natural niacin is still the best way to lower your LDL (bad) cholesterol that signifies calcification, and raise your HDL (good) cholesterol that removes the (bad) cholesterol before it calcifies your arteries and organs.
One example would be Niacin-Time, among other brands of niacin, with cholesterol lowering abilities. You can buy niacin over the counter in either the non-flush form or the regular. But some doctors warn their patients not to take the time-release form of niacin, as past studies showed it might damage the liver or cause fatalities. How do consumers make informed decisions about what to do when the LDL cholesterol is judged too high by healthcare professionals and the HDL cholesterol is too low?
The newest study was intended to examine the potential benefits of adding a second drug — either Zetia or niacin — to the treatment regime of people already taking a statin. See the Nov. 16, 2009 article, “New Study Compares the Effectiveness of Cholesterol Controlling Drugs.”
That small study published in The New England Journal of Medicine compared the effectiveness of two drugs used in combination with a statin (Simvastatin or Atorvastatin) to control cholesterol levels. Also see the NY Times article, Nov. 16, 2009, “Study Raises Question About Cholesterol Drug’s Benefit.” The results of the study, published in The New England Journal of Medicine, were presented Sunday night, November 15, 2009 at an annual meeting of the American Heart Association.
In the latest study, participants were randomly assigned into two groups, one group took Abbott Laboratories extended-release niacin, the other was given Merck and Schering-Plough’s ezetimibe (Zetia). Niacin can increase HDL cholesterol, known as good cholesterol because it is believed to scavenge bad cholesterol and remove it from the body. Researchers measured the differences in changes to arterial wall thickness in the two groups.
Would you rather take an over-the-counter vitamin (niacin–vitamin B3) or a prescription drug? If you still want a prescription, should you ask your doctor to prescribe Niaspan because then your doctor would be managing and testing how the Niaspan is working, how it’s treating your liver, for example? Niaspan, the prescription form of Niacin is listed in the Physician’s Desk Reference book of drugs.
Numerous studies compared Niaspan to a brand of lovastatin with extended release niacin. Also studies compared the special matrix of Niacin Time. For example a study showed Niacin-Time got into the bloodstream in a more convenient way.
On the other hand, you’ll hear niacin has been linked to abnormal liver enzymes such as elevated alkaline phosphatase. That’s why you’ll want your doctor to check your levels of liver enzymes. Here’s a question for your doctor: Did the possible liver abnormality that caused the high cholesterol in the first place also cause the liver enzyme elevations? Or was it the niacin? People on placebos also may have elevated liver enzymes. So that’s a problem your doctor will have to figure out through testing.
In the meantime, vitamin B3 (niacin) works well along with most of the other nutrients you need. You can’t use one vitamin as a drug alone by itself. It works when combined with the complex of all the other vitamins, minerals, and nutrients you take in daily.
Ask your doctor this second question: When taking the prescription form of niacin called Niaspan, is there a raised chance or isn’t there a raised chance of liver toxicity because the dosage is so high? On the other hand, if you ask your doctor if your body is healthy enough to take over-the-counter niacin such as Niacin-Time, what is the best way to combine Niacin Time with other nutrients and/or supplements or foods that make it possible to get good cholesterol results from a lower dose of niacin?
Also ask your health care professional whether niacin is better because studies have confirmed its superior ability to get into the bloodstream better, to be better absorbed? That way a lower dose works just as well. And ask your doctor does that mean that a lower dose of niacin is a safer dose? For example, does a lower dose mean less chance of liver trouble caused by too high a dose or too fast a dose of niacin?
So the main question you want to ask your health care professional is what’s the benefits of Niacin-time compared to niacin over the counter, compared to Niaspan? You want to weigh benefits against risks and find out what your liver enzymes are doing with a simple blood test.
Other tests you’ll want to have done is to find out whether you have high fibrinogen. That protein shows you have an inflammation that might cause blood clots. And you want to find out whether you have a low HDL. You want to raise your HDL if it’s too low. A low HDL is worse than a high LDL as long as your HDL is high. For the HDL, the higher the better, regardless of how high your LDL is.
You also want to find out whether you have elevated lipoprotein A, called Lp(a). So get tested. It’s a simple blood test to find out all these answers. How niacin comes into this picture is that niacin decreases “cholesterol synthesis” in a safer way than most prescription drugs. You see, niacin, according to studies, works better than the statins in lowering fibrinogen, raising HDL, and lowering Lp(a).
Simply put, niacin is safer, but get tests anyone. You never know when you’re the one who can or can’t take niacin. If you look at niacin, it’s Vitamin B3. Take a look at the studies in the Journal of the American Medical Association from recent studies as well as past studies. The research in one study showed that niacin raised the good cholesterol (HDL) 29 percent, and lowered trigylcerides 28 percent.
In that same study, the statin drug tested then, did not do the same job. In another study, niacin reversed cholesterol transport. In another study, niacin reversed artery disease. Some doctors talk about Niacin-Time benefits. Other doctors warn you to test your liver enzymes so you won’t have a fatality from too quick and too high a dose of niacin. That’s why it’s important to talk to several health care professionals and get a liver enzyme test to find out how your liver responds to changes.
If you turn to red yeast rice, it’s a form of a statin, but some brands might contain citrinin, a mold toxin that might damage your kidneys. That’s why you want a product without citrinin. One safe brand is Wakunaga’s Kyolic Formula 107 Red Yeast Rice. It doesn’t have citrinin, according to the book The Cholesterol Hoax, page 49, in the section, “Not All Red Yeast Preparations are Safe or Even Effective,” by Sherry A. Rogers, M.D.
Vitamin C also is good for cholesterol when you lool up studies dating back to the 1950s. Some studies in the past have noted that a vitamin C deficiency causes high cholesterol, according to the book, The Cholesterol Hoax, by Sherry A. Rogers, M.D., page 55.
If you’re deficient in vitamin C, naturally your bile acids are going to be reduced because vitamin C is required to change cholesterol into bile. You need bile because it helps you absorb fat-soluble acids, vitamins, and other nutrients from food. All these nutrients are supposed to balance your cholesterol. What consumers need to know, as they talk to health care professionals, is to compare studies of the past with the present.
A generation ago researchers tested vitamins. Currently scientists compare prescription drugs. It’s news when vitamins are actually compared to drugs and perform better at lowering LDL and raising HDL cholesterol, which is what the goal is for health. Here is a resource list below of articles on the latest studies comparing niacin, that is vitamin B3 against prescription drugs. It’s news when vitamins perform better at lowering the bad and raising the good cholesterol.
What’s the verdict on niacin going to be? On one hand the latest study was small, but on the other side, most consumers would rather use vitamins and nutrients as long as what is used is safer, works well, and does a better job of normalizing cholesterol.
The idea of using a vitamin you can buy over the counter at a health food store or supermarket sounds great in the face of rapidly rising drug prices. In the past year, the big pharmaceutical industry has raised the wholesale prices of brand-name prescription drugs by around 9 percent, according to industry analysts.
Health food stores selling vitamins look at the more than $300 billion nation’s drug bill. By raising the wholesale prices of prescription drugs by 9 percent, another $10 billion is addded to the nation’s drug bill.
Niacin, a vitamin, if it continues to prove that it works well to lower the “bad” cholesterol and raise the “good” cholesterol over the long run, might look good to consumers considering the effects of the highest annual rate of inflation for prescription drubs since 1992. For further information on rising drug prices, see the New York Times article published in the Sacramento Bee on November 16, 2009, “Drug prices rise at rapid pace: industry has vowed to make cuts in future,” by Duff Wilson, New York Times. Also see, “Prescription Drugs: High Costs, Tough Choices.”
What The Latest Studies Report on Niacin Compared to Prescription Statins and other Drugs
Niacin shrinks artery plaque; Merck’s Zetia does not and may carry risks, new study finds
Niaspan has been gaining but lags far behind the prescription statins — 5.8 million prescriptions in 2008, up 11 percent from 2007.
Niacin beats Zetia in the ARBITER 6-HALTS trial
According to the New England Journal of Medicine, boosting HDL cholesterol with extended-release niacin (Niaspan) is a more effective way of slowing atherosclerosis in high-risk patients on long-term statin therapy than seeking additional LDL cholesterol reductions by adding ezetimibe.
In patients with elevated cholesterol levels, statin therapy reduces the incidence of cardiovascular events by 25 to 45%. Despite the administration of a statin, many patients require additional lipid-lowering therapy because their target lipid-level goals are not reached or they have a cardiovascular event. Treatment can be intensified through further reductions in low-density lipoprotein (LDL) cholesterol or attempts to raise high-density lipoprotein (HDL) cholesterol levels.
New Study Raises New Questions About Cholesterol Drug Zetia.
This new study reported November 15, 2009 raised more questions about ezetimibe (Zetia), a drug used by millions of Americans in tandem with statins to lower LDL, or “bad,” cholesterol.
According to the article, ARBITER-6 HALTS clinical trial had been stopped early in June after it was discovered that LDL-cholesterol-lowering Zetia was less effective than extended-release niacin (Niaspan), which raises HDL, or “good,” cholesterol levels, in reducing plaque build-up in the arteries.
Why are clinical trials terminated early? The answer is safety issues rather than a finding of success, which could be temporary or permanent. But the niacin combination also reduced the number of heart attacks and deaths. For more information on this study and to read the entire article on the ARBITER-6 HALTS clinical trial that was stopped early in June, check out the drugs.com website for the latest medical news.
A New Cholesterol Study Puts Focus on Merck Drugs New York Times – Nov 12, 2009. According to this New York Times article, niacin can increase HDL cholesterol, known as good cholesterol because it is believed to scavenge bad cholesterol and remove it from the body.
New Study Compares Effectiveness of Cholesterol Controlling Drugs
Study Raises Question About Cholesterol Drug’s Benefit
Drug Side Effects