Were you one of several million Americans who woke up with high blood pressure on Monday? The American College of Cardiology and the American Heart Association released new blood pressure guidelines on November 13, 2017. The goal is to enhance awareness about elevated blood pressure and emphasize the importance of managing elevated blood pressure through healthy lifestyle changes and medications with the ultimate goal of reducing the risk of heart disease and stroke (cardiovascular disease).The guidelines have lowered the threshold for the diagnosis of high blood pressure (hypertension) and this change will impact the care of several million Americans.
Using niacin to improve cholesterol levels doesn’t reduce heart attack or stroke in high risk patients
We’ve all heard that lowering LDL or “bad” cholesterol levels and raising HDL or “good” cholesterol is good for the heart. When lifestyle changes have not been adequate, most treatment effort in the management of heart disease and stroke risk has focused on lowering the LDL or “bad” cholesterol using a class of drugs called statins. In recent years, the use of niacin – a vitamin B3 – in addition to standard statin therapy has been increasing in the U.S. The main effect of niacin is in raising HDL or “good” cholesterol and this was hoped to result in improving heart attack and stroke prevention beyond what was obtained through the use of statins. But recently reported results from a large study state that the long-term effects of niacin do not lead to better outcomes.
“And in fact, niacin use may even be harmful,” explains Dr. Woubeshet Ayenew, a cardiologist at Hennepin County Medical Center, who is referring to a recent study in the New England Journal of Medicine that associated niacin with infections, skin problems, and diabetes complications. “While niacin can increase HDL levels and lower LDLs and triglycerides, these apparently favorable changes in the lipid levels did not reduce heart attack and stroke when high risk patients were followed on niacin over the long-term,” says Dr. Ayenew. “The effect or benefit of niacin on patients without prior vascular disease was not looked at in these studies.”
“In light of this research, high-risk patients with prior heart attack, stroke or diabetes with arterial blockages who are currently taking niacin with their statin should review their treatment plan with their provider.”
Dr. Ayenew also asserts that pursuing a healthy lifestyle is still the most beneficial and safest way to avoid cardiovascular disease. If medications are needed to supplement healthy lifestyles, it does appear that statins are very effective and have a better safety profile compared to vitamin B3 or niacin.
Woubeshet Ayenew practices in HCMC’s Cardiology Clinic located in downtown Minneapolis, as well as HCMC’s Brooklyn Center Clinic. He was the local principal investigator for the AIM-HIGH trial that looked at the impact of niacin on people with vascular disease. The cardiology clinic was recently identified as the number one rated cardiology clinic by patients for “overall provider experience” in Minnesota, according to results published by Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CGCAHPS), a tool used by the Centers for Medicare and Medicaid Services to collect patient feedback.