Fight Cholesterol with Niacin

Posts Tagged ‘triglycerides’

Expert Opinion on Pharmacotherapy - Niacin: a lipid polypill?

Thursday, November 27th, 2008

by Karam Kostner‌ & Soneil Gupta

University of Queensland, Department of Cardiology, Mater Hospital, Raymond Terrace, South Brisbane 4101, Australia +61 4 38638617; k.kostner@uq.edu.au

Niacin is one of the oldest yet also most diverse lipid lowering agents. As it not only lowers low-density-lipoprotein (LDL) cholesterol, triglycerides (TG) and lipoprotein(a) [Lp(a)] but also increases high-density-lipoprotein (HDL) cholesterol, it is useful for treating a wide variety of lipid disorders including mixed hyperlipidaemia, hypertriglyceridaemia and isolated low HDL cholesterol, as well as elevated Lp(a).

Niacin, which exists in several different formulations, such as immediate release (IR), extended release (ER) and slow release (SR) niacin, has several modes of action: it modulates liver TG synthesis, which leads to increased intracellular apolipoprotein (apo) B degradation and increases TG lipolysis in adipose tissue. Recently, a specific niacin receptor has also been discovered. Several clinical outcome trials have demonstrated that niacin reduces coronary artery disease risk in combination with statins and two large mortality trials are currently underway looking at hard end-point reduction with niacin and statin compared to statin alone.

Niacin’s major adverse event (AE) is flushing, and this prevents many patients from either taking it or reaching target doses of this drug. Flushing incidence and intensity is reduced with ER-niacin and by co-administration of aspirin and a selective or non-selective prostaglandin inhibitor.

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Tags: Enduracin, extended release (ER), hypertriglyceridaemia, lipoprotein(a), niacin, triglycerides
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Triglyceride as a risk factor for coronary artery disease

Monday, October 27th, 2008

Gotto AM Jr.Cornell University Medical College, New York, New York, USA.The data for an independent association between triglyceride concentrations and risk for coronary artery disease (CAD) are equivocal, unlike the data for low-density lipoprotein (LDL) cholesterol and high-density lipoprotein (HDL) cholesterol, which show strong, consistent, and opposing correlations with CAD risk.

There is some evidence for triglyceride as an independent risk factor in certain subgroups, for example, women 50-69 years of age (Framingham Heart Study) and in patients with noninsulin-dependent diabetes. However, the evidence is stronger for triglyceride as a synergistic CAD risk factor. For example, patients with the “lipid triad” of high LDL cholesterol, low HDL cholesterol, and high triglyceride accounted for most of the event reduction with lipid-lowering therapy in the Helsinki Heart Study.

An important confounder of the correlation between triglyceride and CAD risk is the heterogeneity of triglyceride-rich lipoproteins: the larger triglyceride-rich particles are thought not to be associated with CAD risk, whereas the smaller (and denser) particles are believed to be atherogenic. At present, measurement of fasting triglyceride levels and triglyceride assessment in conjunction with LDL cholesterol and HDL cholesterol concentrations are the most practical methods of evaluating hypertriglyceridemia in CAD risk, although postprandial lipemia may prove a better indicator of atherogenicity.

Management of hypertriglyceridemia should initially focus on nonpharmacologic therapy (i.e., diet, exercise, weight control, and alcohol reduction). In diabetic patients, meticulous glycemic control is also important. However, if this approach proves inadequate, there are several pharmacologic options. Fibrates may be effective in decreasing triglyceride and increasing HDL cholesterol.

Nicotinic acid (niacin) has been shown to decrease triglyceride, increase HDL cholesterol, lower LDL cholesterol, and decrease lipoprotein(a); it also decreases fibrinogen. The statins appear to be effective in decreasing triglyceride and LDL cholesterol in hypertriglyceridemia; however, they do not normalize metabolism of apolipoprotein B, and HDL cholesterol may remain low. Therefore, combination with a fibrate or niacin may be appropriate. Attention to hypertriglyceridemia with respect to increased CAD risk represents an important step in assessing global risk for CAD development.PMID: 9819100 [PubMed - indexed for MEDLINE

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Tags: CAD risk factor, enduracine, high-density lipoprotein, independent risk factor, Lipoprotein, niacin, triglycerides
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Niacin Plus Exercise: A Heart-Healthy Combo?

Friday, September 19th, 2008

By Kimberly Beauchamp, ND - (Am J Clin Nutr 2008;88:30–7)

Niacin and aerobic exercise can each separately help to lower blood fats called triglycerides. A study in the American Journal of Clinical Nutrition recently explored how these therapies might work together to promote heart health in people with the metabolic syndrome.

The metabolic syndrome is a group of risk factors for cardiovascular disease and type 2 diabetes, including abdominal obesity (tummy fat), insulin resistance (poor ability of the body to respond to fluctuations in blood sugar), low HDL (“good”) cholesterol, high blood pressure, and high triglycerides. When a person has three or more of these factors, they are said to have the metabolic syndrome, which affects an estimated 50 million Americans.

A two-pronged approach to treating the metabolic syndrome

The new study investigated the combined effects of niacin and aerobic exercise in 15 men with the metabolic syndrome.The study consisted of three parts:

• During the first, the men ate a high-fat meal only (control), containing 100 grams of fat;
• in the second part, the men exercised for about 50 minutes, one hour before a high-fat meal;
• In the third part, they took extended-release niacin in increasing dosages for six weeks (up to 1,500 mg per day) and then exercised for 50 minutes, one hour before a high-fat meal.

Blood levels of triglycerides and insulin were measured to assess the response to these therapies. Compared with the control, triglyceride levels were 32% lower after the high-fat meal that was preceded by exercise. This effect lasted for up to six hours.

While niacin lowered fasting triglyceride levels by 37%, niacin plus exercise did not decrease triglyceride levels immediately following the high-fat meal, suggesting that niacin canceled out the positive effect of exercise on after-meal triglyceride levels.

“While these results would appear to promote the use of one intervention over the other, it is important to note that a number of recent investigations provide evidence that niacin has important direct vascular anti-inflammatory properties which have not been observed with exercise alone,” said Dr. Eric Plaisance, the study’s lead author.

“I would recommend a combination of exercise and niacin for patients with the metabolic syndrome; not only to reduce fasting and postprandial triglycerides, but also to directly reduce the vascular inflammatory cascade that is so prevalent in this population.”

A potential drawback to niacin therapy is that it can decrease insulin sensitivity; this effect was not seen when niacin was combined with exercise, suggesting that exercise can help offset the negative effects of niacin on blood sugar.

Kimberly Beauchamp, ND, earned her bachelor’s degree from the University of Rhode Island and her Doctorate ofNaturopathic Medicine from Bastyr University in Kenmore, WA. She cofounded South County Naturopaths in Wakefield, RI. Dr. Beauchamp practices as a birth doula and lectures on topics including whole-foods nutrition, detoxification, and women’s health.

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Tags: cardiovascular disease, Enduracin, Metabolic Syndrome, niacin, triglycerides
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Understanding Niacin Formulations

Sunday, February 24th, 2008

Here’s an excellent paper that provides a thorough overview of niacin formulations, uses & effects.

Niacin is a safe and effective therapeutic agent for the management of patients with dyslipidemias. Achieving the most therapeutic benefit from niacin therapy with minimal adverse effects is best done under the supervision of a healthcare practitioner.

In summary, niacin is the only lipid-modifying agent available that favorably affects all aspects of the lipid profile, and should be considered an important therapeutic option for patients with dyslipidemias.

Understanding Niacin Formulations
John A. Pieper, PharmD
THE AMERICAN JOURNAL OF MANAGED CARE

Abstract

Niacin is an important therapeutic option for the treatment of dyslipidemias and is the only agent currently available that favorably affects all components of the lipid profile to a significant degree.

Niacin has consistently been shown to significantly reduce levels of total cholesterol, low-density lipoprotein (LDL) cholesterol, triglycerides, and lipoprotein (a), while having the greatest high-density lipoprotein (HDL) cholesterol–raising effects of all available agents. Niacin has also been shown to significantly reduce coronary events and total mortality. Niacin is available in 3 formulations: immediate-release (IR), sustained-release (SR), and a newer formulation, niacin extended-release (ER), all of which differ in their pharmacokinetic, efficacy, and safety profiles. Conventional niacin therapy has notable limitations that include flushing, most often seen with IR formulations, and hepatotoxicity, associated with SR formulations.

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Tags: cholesterol, high-density lipoprotein, low-density lipoprotein, niacin, triglycerides
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DISCOVERIES

Monday, February 18th, 2008

Niacin’s efficacy in the lowering of harmful triglycerides is well known and accepted.
Again & again, recent health discoveries confirm niacin’s value.

(excerpt from. . .) Chicago Tribune

– HealthDay News February 17, 2008

Triglycerides a big cardiac threat

A new study showing that high levels of triglycerides are strong predictors of cardiac trouble strengthens the case for including measurement of the blood fats in prevention programs.

“Triglycerides traditionally have been viewed as second-class citizens,” said Dr. Michael Miller, director of preventive cardiology at the University of Maryland Medical Center and lead author of the report. “LDL cholesterol has always taken center stage.”

When study participants were divided into four groups on the basis of both LDL and triglyceride levels, those in the group with under 150 for triglycerides and under 70 for LDL did the best, with a 28 percent lower risk than those in the group with the highest readings.

Self-help: Eat a Mediterranean diet rich in vegetables, fruits and fish. Omega-3 fatty acids can lower triglyceride levels, as can niacin, and exercise is beneficial, Miller said.

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Tackling Triglycerides: 8 Ways to Solve a Big Fat Problem, From the Harvard Heart Letter

Saturday, February 2nd, 2008

BOSTON, Jan. 30 /PRNewswire-USNewswire/ — When it comes to heart health, the largest and most common form of fat in food and the bloodstream –triglycerides — has taken a back seat to “bad” LDL cholesterol and “good” HDL cholesterol in the public’s awareness. That’s changing as researchers get a grip on how triglycerides influence the risk of heart disease, reports the February 2008 issue of the Harvard Heart Letter.

Triglycerides are in the danger zone when they slide above 200 milligrams per deciliter of blood. To keep triglycerides in check, lifestyle changes are usually the best place to start, notes the Harvard Heart Letter. These eight steps can lead to impressive reductions in triglycerides:

1. Beware of bad fats. Cut back on saturated fat (found in red meat and full-fat dairy foods) and trans fat (in some fried and commercially prepared foods).

2. Go for good carbs. Eat whole grains and cut back on sugary drinks and foods.

3. Check your alcohol. Moderate drinking is good for the heart, unless you are a “responder” in whom alcohol dramatically boosts triglycerides. To determine if you’re a responder, avoid alcohol for three weeks and have your triglycerides tested.

4. Go fish. Omega-3 fats in some fish lower triglycerides. Have fish twice a week.

5. Aim for a healthy weight. If you are overweight, aim to lose at least 5% to 10% of your weight to lower triglycerides.

6. Get moving. Exercise lowers triglycerides and boosts HDL.

7. Stop smoking. Smoking isn’t good for triglyceride levels (or anything else).

8. Get help from a medication. Niacin, fibrates, fish oil, and cholesterol-lowering statins have all been shown to lower triglycerides.

Also in this issue:

– Mini strokes are a major problem

– ACE inhibitors vs. angiotensin-receptor blockers for blood pressure

– Surgery or angioplasty for clogged neck artery?

– Ask the Doctor: Are all dark chocolates good for the heart?

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Tags: HDL cholesterol, LDL cholesterol, niacin, Omega-3, triglycerides
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Don’t overlook niacin for treating cholesterol problems

Saturday, January 5th, 2008

Date updated: August 21, 2006

Content provided by Harvard Health Publications

If you can conquer or cope with the “niacin flush,” this B vitamin can do wonders for cholesterol.

If a drug company wanted to create the ideal cholesterol-lowering medication, here’s what it would make: a safe, inexpensive pill that lowered levels of LDL (bad) cholesterol and triglycerides, raised HDL (good) cholesterol, and changed the sizes of cholesterol particles to make them less harmful or more beneficial. Of the current cholesterol-lowering drugs on the market, niacin comes closest to this.

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Safety Considerations with Niacin Therapy

Wednesday, January 2nd, 2008

John R. Guyton MD and Harold E. Bays MD
Duke University Medical Center, Durham, North Carolina, USA
Louisville Metabolic and Atherosclerosis Research Center, Louisville, Kentucky, USA.

Available online since November 28, 2006.

Niacin has beneficial effects on plasma lipoproteins and has demonstrated clinical benefits in reducing cardiovascular events and atherosclerosis progression. The side effects of niacin, however, have limited its use in general clinical practice…

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Tags: cardiovascular, cholesterol, clinical benefits, lipids, niacin, plasma lipoproteins, triglycerides
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First presented in 1999 to leading cardiovascular specialists in Moscow, Russia

Saturday, December 8th, 2007

Wax-Matrix Sustained-Release Nicotinic Acid

Joseph M. Keenan, M.D.
Professor, University of Minnesota
Department of Family Practice

INTRODUCTION:
Today we have more options than ever for the pharmacological management of hyperlipemia. Some of the newer agents have unprecedented potency in lowering LDL cholesterol while others may be better at reducing triglycerides or improving HDL. Keeping track of which drugs are best for which lipid problems can be a challenge in the everyday practice of medicine. I offer here a simple rationale for selecting a first choice in lipid management. If you follow this rationale I think you will find that nicotinic acid or niacin is the best first choice, and that among the niacin preparations wax-matrix CNA (controlled release niacin) is by far the best available.
SELECTING A LIPID LOWERING DRUG:. . .

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Tags: cholesterol, controlled release, Enduracin, HDL, hyperlipemia, LDL, lipid management, lipoproteins, niacin, nicotinic acid, triglycerides, Uncategorized, Wax-matrix
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