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Niacin Slashes Heart Attack Risk in Diabetics

Blood sugar rises, but heart is grateful still

WEDNESDAY, Nov. 20, 2002 (HealthDayNews) -- Niacin supplements can reduce by about 50 percent the chance of a second heart attack in people with diabetes and milder blood sugar problems, who are at sharply increased risk of cardiac diseases.

So says a new study, which found that although the B vitamin nudges blood sugar higher, it more than overcomes that effect by suppressing dangerous blood fats that promote heart attacks. The study also found that diabetics seemed to derive more heart protection from niacin than people without the disease.

"In the past, we've been hesitant to use it because of the increase in glucose levels," said Dr. Michael Davidson, director of preventive cardiology at Rush Medical College in Chicago, who was familiar with the findings. "But even though it goes up some, the benefits of raising HDL, lowering LDL and triglycerides more than offsets that risk. The net benefit is still significant."

LDL (the "bad" cholesterol) and triglycerides are linked to heart problems, while increasing levels of HDL (the "good" cholesterol) protect the heart and vessels. The magnitude of niacin's effects on lowering heart attack risk is similar to that of other drugs, including aspirin, statins and other treatments that cut cholesterol, and beta-blockers, experts said.

The latest work was led by Paul Canner of the Maryland Medical Research Institute in Baltimore, who presented the findings today in Chicago at a meeting of the American Heart Association. The study was funded by Kos Pharmaceuticals, which makes a slow-release prescription version of niacin called Niaspan.

The study used an immediate-release form of niacin, which is found in fortified cereals as well as grains, meats, nuts and other foods. But Dr. Mark McGovern, medical director for the Miami-based Kos, said his product would be similarly effective. The Food and Drug Administration approved Niaspan in 1997. Since then, 8 million prescriptions have been written for the drug, McGovern said.

In a 1975 study called the Coronary Drug Project, Canner's group showed that people who took up to three grams a day of niacin reduced their risk of recurrent heart attacks by 28 percent after six years, compared to those who took sugar pills. And after 15 years of follow-up, their overall risk of death was 11 percent lower.

At the time, the researchers didn't ask whether the effect was different in people with blood sugar trouble. So in the new analysis, they divided 1,119 of the original subjects into four categories depending on their ability to process blood sugar.

This time, Canner and his colleagues found that niacin reduced the risk of a second, non-fatal heart attack by 28 percent in people without diabetes, and by 54 percent in those with the blood sugar disorder. The trends for overall mortality were similar.

Dr. John Buse, who directs the diabetes care center at the University of North Carolina School of Medicine, said the original formulation of niacin wasn't tolerated well. But Niaspan, which he has studied, appears to be a gentler product.

"There has been some discussion that perhaps there would be differences in the rate of absorption, but to date it looks good. It seems to do all the right things," Buse said.

An estimated 17 million Americans have diabetes, and 16 million have the Type II form of the disease in which their cells become resistant to insulin. Another 16 million people have "prediabetes," putting them at high risk of developing the full-blown sugar disorder.

Cardiovascular disease is the leading killer of diabetics, who face two to four times the normal risk of heart attacks as a result of their condition.

What To Do

Niacin isn't without side effects, the most common of which is flushing and itching in the face and neck, which in some people can be severe.

For more on diabetes, try the National Institute of Diabetes and Digestive and Kidney Diseases. For more on heart attacks, visit the American Heart Association.

SOURCES: Michael Davidson, M.D., director of preventive cardiology, Rush Medical College, Chicago; Mark McGovern, M.D., medical director, Kos Pharmaceuticals, Miami; John B. Buse, M.D., Ph.D., director, diabetes care center, University of North Carolina School of Medicine, Chapel Hill; Nov. 20, 2002, presentation, American Heart Association meeting, Chicago
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