Statin/Niacin Combination Might Reverse Heart Disease

A 2001 University of Washington cardiovascular study is already influencing the treatment of patients at risk of heart disease. Managing atherosclerosis with a combination of a statin and niacin appears to more than double the improvement gained from standard statin-only cholesterol-lowering treatment. The same study also found that antioxidants, often promoted as improving cardiovascular health, appear to offer no benefit.

Following up his classic 1990 study that reported the first clinical outcomes of statin treatment, Dr. B. Greg Brown, professor of medicine in the Division of Cardiology, led the research. Published in The New England Journal of Medicine, the latest study tracked 160 patients who had low levels of high-density lipoproteins (HDL) or good cholesterol, and moderately elevated levels of low-density lipoproteins (LDL) or bad cholesterol. Over three years, all 160 patients were treated with a combination of simvastatin and niacin, a B-complex vitamin.

Typically, statins lower levels of LDL, while niacin raises levels of HDL. The effect of a combination treatment, Brown showed, is to reduce the risk of a major blood vessel problem -- whether a stroke, a heart attack, cardiac death, or a need for heart surgery -- by 70 percent, compared to the well-established 30 percent risk-reduction with a statin alone. For most patients in the study, the combination treatment not only slowed the progressive narrowing of the arteries but actually reversed it.

In early 2002, the first statin/niacin combination drug was commercially released.

The research finding on antioxidants, later confirmed by a larger British study, indicated a slight adverse impact on cardiovascular health from what the dietary supplements industry has considered the most promising combination of antioxidants: vitamins C and E, beta carotene, and selenium. The antioxidants appear to impede the beneficial effect of the statin/niacin combination.