Cholesterol Drug Plus Niacin May Slash Heart Risks
NEW YORK (Reuters Health) - Treatment combining the cholesterol drug simvastatin with the B vitamin niacin lowers the risk of heart attack and other artery-disease complications by up to 90% in some patients, according to researchers.
Their study of 160 adults with clogged heart arteries and low HDL (''good'') cholesterol showed that 3 years of the treatment combo improved HDL levels, caused artery blockages to recede and significantly lowered heart complications compared with an inactive placebo.
On the other hand, treatment with a mixture of antioxidant vitamins--which some research has suggested could fight heart disease--made no significant dent in patients' heart risks. Moreover, when the vitamins were added to the simvastatin-niacin regimen, they blunted some benefits of the combination therapy, a finding researchers say is surprising.
Dr. B. Greg Brown and his colleagues report their results in the November 29th issue of The New England Journal of Medicine.
Both lowering LDL, the "bad'' cholesterol, and raising HDL help lower the risk of cardiac "events'' such as heart attack. Brown, a researcher at the University of Washington in Seattle, and his colleagues reasoned that cutting LDL with a statin drug and raising HDL with niacin could potentially double the benefits for at-risk patients. And since low HDL may reflect an antioxidant deficiency, treatment with such vitamins could be expected to confer still more protection.
In the study, patients took either a combination of simvastatin (Zocor) and niacin alone, antioxidants alone, simvastatin-niacin plus antioxidants, or placebo. The antioxidant treatment included vitamins E, C, beta-carotene and selenium.
Over 3 years, patients on simvastatin-niacin were 60% to 90% less likely than placebo patients to have a heart attack or stroke, need artery-clearing surgery or to die from causes related to their artery disease. These patients also showed a slight regression in their artery blockages, while on average all of the other groups showed worsening artery narrowing.
Patients on the combination plus antioxidants had more artery narrowing after 3 years and their HDL increases were not as strong compared with patients on simvastatin-niacin alone. Their risk of cardiac complications was lower, but not as low as that of patients on the combination alone.
Treatment with antioxidants alone actually lowered an HDL component called HDL2 and did not cut patients' risk of heart attack and other complications.
"Unless more compelling evidence appears,'' Brown's team concludes, "we see little justification for the use of antioxidant vitamins for the prevention of cardiovascular events.''
In a telephone conference, Brown told reporters he believes too few heart patients with low HDL are receiving niacin, but predicted that "we'll see more and more use'' of the B vitamin.
As for antioxidants, he said that statin users who "really want to raise HDL...probably should not be using antioxidant vitamins.''
Brown also offered this advice to people like those in the study--artery disease patients with low HDL and a tendency toward high triglycerides: ``I would be asking my physician, 'how about adding niacin to the statin you already have me on?'''
He noted that statin drugs other than simvastatin would likely have similar effects when coupled with niacin.
But the benefits of the statin-niacin combo may not be the same for heart patients with elevated LDL but normal HDL, according to an editorial accompanying the journal report.
And the possibility that antioxidants may benefit these and other patients ``has not been excluded,'' notes Dr. Jane E. Freedman of the Boston University School of Medicine in Massachusetts.
"The difficult thing with this study is extending (the findings) to other groups,'' she told Reuters Health.
And the fact that antioxidant treatment lessened the benefits of simvastatin-niacin is "tough to draw any conclusions from,'' Freedman added. Because the study used an antioxidant ``cocktail,'' she explained, the effects of the individual vitamins cannot be weeded out.
Freedman also stressed that the current findings "do not change the recommendation at all'' for the general public to follow antioxidant-rich diets, which include high amounts of fruits and vegetables. Such diets are believed to help ward off a range of diseases.
SOURCE: The New England Journal of Medicine 2001;345:1583-1592, 1636-
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