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Statin-Niacin Combination Sharply Cuts Heart Risk

But study finds antioxidants blunt benefit

WEDNESDAY, Nov. 28, 2001 (HealthDayNews) -- Combining a cholesterol-lowering statin drug with niacin can substantially reduce the risk of heart attacks and death for some patients with advanced heart disease, a study finds.

But the study finds no benefit for the antioxidant vitamins that many doctors prescribe to reduce cardiovascular risk.

The statin drug lowers blood levels of LDL cholesterol, the "bad" kind that forms artery-blocking deposits, while niacin raises the level of HDL cholesterol, the "good" kind that helps clear arteries, says Dr. B. Greg Brown, professor of medicine at the University of Washington and lead author of a report in the Nov. 29 issue of The New England Journal of Medicine.

"The therapies we studied in the past focused on lowering the bad cholesterol or raising the good cholesterol. If we do both, we get a double benefit," Brown says.

Single-drug treatment typically reduces the risk of death, a heart attack, or hospitalization for chest pain about 35 percent, Brown says. The reduction for patients getting both a statin and niacin was 70 percent.

"The disease was stopped in its tracks and actually got better," Brown says.

The study included 160 patients, all with established heart disease and low levels of HDL cholesterol. At least 40 percent of people with heart disease fit that profile, says the journal report. Subjects were divided into four equal groups. Some got a statin and niacin, some got antioxidant vitamins (C, E and beta carotene), some got both the drugs and the vitamins, and some got an inactive substance.

The biggest benefits were for patients getting the statin and niacin. In addition to the reduction in heart attacks and other problems, detailed examinations showed an impressive reduction in formation of artery-blocking deposits. But that beneficial action was lessened in the patients who got the antioxidant vitamins in addition to the drug and niacin, Brown says.

"Antioxidant vitamins blunt the rise in HDL cholesterol," he says. "If you want to raise HDL levels with therapy, you should not be using antioxidant vitamins. They are not beneficial, and it would be a waste of money."

Another study reported in the same journal finds that another, unrelated group of vitamins can benefit some heart patients: those who have had the artery-opening procedure called angioplasty. Vitamins that lower blood levels of a substance called homocysteine reduce the risk that the arteries will become blocked again, says a team led by Dr. Guido Schnyder, a Swiss physician who is a visiting scholar at the University of California at San Diego.

The incidence of new blockages was reduced by nearly half in patients who took a daily pill containing 1 milligram of folic acid, 400 micrograms of vitamin B-12 and 10 milligrams of vitamin B-6, the researchers report.

The result is at least partial proof of the theory that high blood levels of homocysteine are a risk factor for artery blockage, Schnyder says. There is still the possibility that another factor is involved, but "I am definitely treating all my patients with the vitamin combination. The risk is zero and the cost is extremely low," he says.

By contrast, some risk is involved with niacin treatment, Brown says. "A small number of patients, maybe 2 or 3 percent, may have a problem with liver enzymes. Niacin therapy should be supervised by a physician," he says.

But under proper supervision, a statin and niacin is "a very good drug combination that stops the disease in its tracks," he says.

What To Do

"If I were a patient with established heart disease, low HDL cholesterol and high triglycerides, I would be asking my physician, 'Should you add niacin to the statin you have me on?'" Brown says.

The American Heart Association has more information on cholesterol-lowering drugs and antioxidants.

SOURCES: Interviews with B. Greg Brown, M.D., professor of medicine, University of Washington, Seattle; Guido Schnyder, M.D., visiting scholar, University of California, San Diego; Nov. 29, 2001 The New England Journal of Medicine
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