Monthly Archives: July 2014

Niacin for cholesterol now linked to death risk, dangerous side effects and no benefits

Integrative LipidologyAfter 50 years of being a mainstay cholesterol therapy, niacin should no longer be prescribed for most patients due to potential increased risk of death, dangerous side effects and no benefit in reducing heart attacks and strokes, writes Northwestern Medicine® preventive cardiologist Donald Lloyd-Jones, M.D., in a New England Journal of Medicine editorial.

Lloyd-Jones’s editorial is based on a large new study published in the journal that looked at adults, ages 50 to 80, with cardiovascular disease who took extended-release niacin (vitamin B3) and laropiprant (a drug that reduces face flushing caused by high doses of niacin) to see if it reduced heart attack and stroke compared to a placebo over four years. All patients in the trial were already being treated with a statin medication.

Niacin did not reduce heart attacks and stroke rates compared with a placebo. More concerning, niacin was associated with an increased trend toward death from all causes as well as significant increases in serious side effects: liver problems, excess infections, excess bleeding, gout, loss of control of blood sugar for diabetics and the development of diabetes in people who didn’t have it when the study began.

“There might be one excess death for every 200 people we put on niacin,” said Lloyd-Jones, chair of preventive medicine at Northwestern University Feinberg School of Medicine and Northwestern Memorial Hospital. “With that kind of signal, this is an unacceptable therapy for the vast majority of patients.”

“For the reduction of heart disease and stroke risk, statins remain the most important drug-based strategy by far because of their demonstrated benefit and their good safety profile,” said Lloyd-Jones, who was a member of the task force that rewrote cholesterol treatment guidelines in 2013 for the American College of Cardiology and the American Heart Association.

Niacin should be reserved only for patients at very high risk for a heart attack and stroke who can’t take statins and for whom there are no other evidence-based options, Lloyd-Jones said.

Niacin raises “good” HDL (high density lipoprotein) cholesterol levels, and having high HDL levels means a lowered risk for cardiovascular events. But clinical trials have not shown that niacin reduced the risk ofcoronary heart disease or the broader cardiovascular disease specifically by raising HDL. Niacin also produces a modest reduction in low-density lipoprotein (LDL cholesterol) and a more substantial reduction in triglyceride levels, which might be expected to lower the risk of coronary heart disease, Lloyd-Jones notes in the article.

But the new study suggests that higher HDL levels only are a sign of lowered risk for heart attacks and stroke. Raising HDL levels with niacin does not appear to impact cardiovascular outcomes nor does lowering triglyceride levels, Lloyd-Jones points out.

“The recent niacin clinical trials offer important new evidence that raising ‘good’ cholesterol (HDL) levels on top of statin therapy does not have the positive outcome that had been hoped for,” said Neil Stone, M.D., the Robert Bonow MD Professor in Cardiology at Feinberg and a cardiologist at Northwestern Memorial Hospital. “Lowering ‘bad’ cholesterol (LDL) with an optimal intensity of tolerated statins and adherence to healthy lifestyle changes remains the most effective approach to prevent strokes and heart attacks for patients at risk of cardiovascular disease.”

http://www.medicalnewstoday.com/releases/279734.php

 

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Heart disease a greatly increased risk for obese young Hispanics

LipidologyObesity is common among U.S. Hispanics and is severe particularly among young Hispanics, according to research in the Journal of the American Heart Association (JAHA).

The first large-scale data on body mass index (BMI) and cardiovascular disease risk factors among U.S. Hispanic/Latino adult populations suggests that severe obesity may be associated with considerable excess risk for cardiovascular diseases.

For U.S. Hispanics, the obesity epidemic “is unprecedented and getting worse,” said Robert Kaplan, Ph.D., lead author, and professor of epidemiology and population health at Albert Einstein College of Medicine in New York City. “Because young adults with obesity are likely to be sicker as they age, and have higher healthcare costs, we should be investing heavily in obesity research and prevention, as if our nation’s future depended upon it.”

Researchers reviewed data from a study of 16,344 people of diverse Hispanic origin in four U.S. cities (Bronx, Chicago, Miami and San Diego). Men were average age 40 and women were average age 41. People with Mexican roots were the largest group (about 37 percent of subjects), followed by those with Cuban (20 percent) and Puerto Rican (16 percent) backgrounds.

They found:

  • Overall 18 percent of women in the study and 12 percent of the men had levels of obesity that signal special concern about health risks, as defined by having a BMI above 35 (BMI is calculated based on height and weight).
  • The most severe class of obesity, (BMI greater than 40, or for a person 5′ 5″ tall, body weight over 240 pounds) was most common among young adults between 25 and 34 years of age, affecting one in twenty men and almost one in ten women in this age group.
  • More than half of the severely obese people had unhealthy levels of HDL cholesterol, the “good” cholesterol, and of inflammation, as measured by a marker called C-reactive protein.
  • About 40 percent had high blood pressure, and more than a quarter had diabetes. Kaplan/2

“This is a heavy burden being carried by young people who should be in the prime of life,” he said. “Young people, and especially men – who had the highest degree of future cardiovascular disease risk factors in our study – are the very individuals who tend to neglect the need to get regular checkups, adopt healthy lifestyle behaviors, and seek the help of healthcare providers.”

Yet compared with the women, high blood pressure and diabetes, both risk factors for heart disease andstroke, appeared to be more tightly linked with severe obesity among men.

The findings for younger Hispanic adults, who are in their child-bearing and child-rearing years, suggest to Kaplan that healthcare providers should take a holistic, family approach to weight management. A host of biological and societal factors that affect parents’ weight could also affect their children, he said.

http://www.medicalnewstoday.com/releases/279406.php