Vitamin B niacin offers no extra benefits to statin therapy

By David Liu and editing by Sheilah Downey

Vitamin B Niacin is often used together with statins to help reduce heart risk, but a new study suggests niacin does not add benefits to statin therapy in seniors already diagnosed with cardiovascular disease.

The study showed the combined use of extended-release niacin in a dose of 1,500 milligrams and traditional cholesterol-lowering therapy or statin therapy each day did not help correct arterial narrowing and dissolve plaque buildup in seniors with coronary artery disease.

Johns Hopkins University researchers João Lima, MD and colleagues tested 145 men and women aged over 65 in Baltimore who had existing atherosclerosis and found addition of niacin into the statin therapy did not further reduce arterial wall thickness.

The same results were found in different statins including atorvastatin (Lipitor), simvistatin (Zocor) and rosuvastatin (Crestor).

However, those who used both niacin and statin reduced bad cholesterol by 5 percent while the good cholesterol (HDL) increased by 14 percent compared to those who took statin only.

"Our findings tell us that improved cholesterol levels from taking combination vitamin B niacin and statin therapy do not necessarily translate into observable benefits in reversing and stalling carotid artery disease," said Lima, professor of medicine and radiology at the Johns Hopkins University School of Medicine

"This does not mean that niacin therapy may not have other cardiovascular benefits, but any such benefits are independent of reducing the amount of plaque buildup and patients should be aware of that."

Lima said the current national treatment guidelines which recommends mainly statin therapy without niacin for preventing arteries from re-clogging and narrowing seems to be sufficient and accurate for clinicians to follow.

It is not clear whether the statin-niacin therapy would reduce death rates from heart disease until an ongoing national study is completed.

It should be noted that the form of niacin used in the study can be available by prescription and all the participants in the study were most vulnerable to coronary artery disease and at risk of suffering an arterial blockage, heart disease or stroke.

All the study subjects had one or more preexisting cardiovascular health issues like heart attack, stroke, coronary artery bypass grafting to resupply blood to the heart, severe chest pain, or angioplasty.

The results were presented Nov 18 at the American Heart Association's (AHA) annual Scientific Sessions in Orlando.

Previous studies found niacin is beneficial.

One previous randomized placebo-controlled, multicenter trial found that taking three grams per day of niacin for six years provided benefits to men and women with a previous myocardial infarction or heart attack.

Canner PL and colleagues conducted the trial of 8,341 men age 30 to 64 years between 1966 and 1975 and found that the vitamin B decreased nonfatal recurrent myocardial infarction by 27 percent but did not reduce total mortality.

However, a 9-year followup after the trial found that patients using niacin were 11 percent less likely to die than those who did not use the vitamin B.

In addition, use of the vitamin B resulted in a 10 percent reduction in total blood cholesterol and a 26 percent decrease in triglycerides.

Because of the adverse side effects associated with high doses of niacin, the vitamin has been recently used in combination with other lipid lowering medications or statins.

In an article, Brown BG and colleagues from the University of Washington School Medicine in Seattle wrote that combined use of niacin (2 to 3 grams per day) and simvastatin offered benefits on serum high density lipid protein or HDL cholesterol and cardiovascular events such as heart attack and stroke, than those who did not use the vitamin B. The patients had coronary artery disease and low HDL levels.