Primary Care Doctor Marc Leavey Discusses Efficacy of Niacin on Cholesterol Levels
Commentary Regarding Research Indicating Niacin May Not Be Effective Treatment For Cholesterol, Cardiovascular Disease
More than a year after its public presentation, the Heart Protection Study 2—Treatment of HDL to Reduce the Incidence of Vascular Events (HPS2-THRIVE) is now in print. With the publication of the HPS2-THRIVE findings this week in The New England Journal of Medicine, it would appear that Niacin, which is administered to patients to raise HDL-cholesterol levels, may be potentially toxic for a large number of patients, thus questioning Niacin’s routine use.
HPS2-THRIVE, along with other trials and studies, has served to undermine the HDL hypothesis, that agents designed to raise HDL-cholesterol levels could reduce the residual risk of cardiovascular disease among patients treated with optimal medical therapy, including statins.
Mercy internist Dr. Marc Leavey, in the practice of primary care for nearly 40 years, offers his insights regarding the role of niacin relative to cholesterol and cardiovascular disease (CVD).
“In my early days of practice, before statins were available, there were precious few medications which showed a significant impact on serum lipid levels. Niacin surfaced as a promising agent, and physicians were told at the time that the drug showed clear positive impact in the fight against heart disease.
“While its prominence on the lipid landscape waned after the advent of the statins, it remained an option in a small subset of people who were felt to be statin intolerant, or in whom the purported HDL raising action of Niacin was a desired action. Side effects were always a problem with the drug, though, and some could not tolerate the pre-dose aspirin any more than they could tolerate the niacin itself. And there were issues with diabetics, where blood sugar control would be impacted by the drug.
“Now, we learn that this troubled pharmaceutical does not appear to have the desired effects, and may, in fact, be more likely to result in harm than good. While shelving Niacin for common use would appear to be in order, one can only hope that there will be ongoing research to see if the effects suggested earlier can be elicited without untoward side effects.
“There are many instances of a proto-drug coming to market, only to be withdrawn and subsequently introduced derivative pharmaceuticals fulfilling the promise of the parent product, without the problems. Perhaps that will be Niacin’s ultimate destiny.”
–Dr. Marc Leavey, Lutherville Personal Physicians, Mercy Medical Center
Founded in 1874, Mercy Medical Center is a university-affiliated medical facility named one of the top 100 hospitals in the U.S. by Thomson-Reuters with a national reputation for women’s health. Mercy is home to the nationally acclaimed Weinberg Center for Women’s Health and Medicine as well as the $400+ million, 20-story Mary Catherine Bunting Center. For more information visit Mercy online at www.mdmercy.com, Facebook, Twitter or call 1-800-MD-MERCY.
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