Niacin: A beneficial drug

Recently we received a question on the blog regarding cholesterol treatment and the use of a test called Lp-PLA2. I thought I might dedicate a blog to the test and the rationale for it. I have discussed before the concept of evaluating your overall risk of cardiovascular disease by the use of the Framingham Risk Calculator as described in my blog from September 4, 2009 . If your risk is low, much of what we do to lower individual risks such as cholesterol or high blood pressure follows a more isolated approach. When the risk is high, a very aggressive approach needs to be taken to lower all the possible risk factors. Obviously, genetics at this time cannot be overcome.

Over time, many tests have come forward regarding cardiovascular risk. Almost all have some small value but none rise to the level of adding them to the risk calculator. Cholesterol has many components and we hold the most important to be LDL levels. If you can lower LDL levels primarily by statin drugs the known benefits are very impressive.

Recently, in the Journal of the American Medical Association (JAMA 2009; 302(4):412-423), a report on Emerging Risk Factors Collaboration was published. Researchers found, after reviewing the records of 126,634 patients, that Lp(a) was associated with risk, but that the effect was modest compared to LDL lowering. The only agent we have to lower the Lp(a) levels is niacin, which also lowers LDL and raises HDL; so it is not specific.

In the example provided in the comment, the substitution of a more potent statin to drive the LDL below 100 would be useful. Lovaza in doses of greater than 1 gram a day may actually raise LDL levels. Niacin in any dose would be the most beneficial drug because it will lower LDL, triglycerides and raise HDL. As you can see, it will also lower Lp(a). Talk to your doctor about taking niacin. In general, we recommend: starting with 500mg a night and increasing the dose to 2000mg if possible very slowly; and taking only slow released compounds after taking an aspirin and before going to bed.

Tags: Framingham Risk Calculator, HDL, JAMA, LDL levels, Lovaza, Lp(a), Lp-PLA2, Niacin, triglycerides

This entry was posted on Thursday, September 17th, 2009 at 6:10 pm and is filed under Cholesterol. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.