AboutTodd Bublitz, RCEP Expertise I can answer questions on Cholesterol & Lipids, Cardiac Rehabilitation, and
preventive cardiology. I can also explain the risk factors for
cardiovascular disease and most cardiac diagnostic tests and procedures.
Experience
Professional Experience Former Lipid Clinic Coordinator for large Cardiology practice. Seventeen years experience in Cardiac Rehabilitation and risk factor modification. Researcher in cardiovascular exercise, cardiac function and cardiac testing.
Developed and maintain Lipid-Clinic.com
Also, Nuclear Cardiology Research Organizations National Lipid Association
American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR)
American College of Sports Medicine (ACSM)
Preventive Cardiovascular Nurses Association (PCNA)
Rocky Mountain Cardiopulmonary Rehabilitation Association (RMCRA)
Education/Credentials Registered Clinical Exercise Physiologist by ACSM Certified as 'Exercise Specialist' by ACSM
Question My husband has some artery build up of plaque and has one stent. Because the plaque is still increasing, his cardiologist has just recommended to increase from 40mg to 80mg Zocor PLUS 1g Niacin. I have read that this is not advisable and would value your opinion please.
Answer Jill,
The combination of a statin (Zocor, Lipitor, Pravachol, etc.) plus niacin has been shown to be extremely effective in slowing, stopping and in some cases, slightly reversing the build-up of cholesterol-filled plaque. I love the combination of statin and niacin! This combination is actually found in a prescription medicine called "Advicor".
It was typically thought that adding niacin when a patient was already taking a statin 'may' increase the possibility of some adverse side-effects that are possible with statins. Therefore, most doctors would tend not to add niacin to a patient's therapy if the patient was on a high dose of a statin (adding niacin to a low or moderate dose of statin was thought to be OK).
However, on March 19, 2007 the National Lipid Association released "Report of the National Lipid Association's Safety Task Force: The Nonstatins" (released as a supplement in The American Journal of Cardiology, Vol 99(6)). This report addressed the very question of "Does adding niacin to statin therapy increase the possibility of adverse statin side-effect?" and the answer was "No". There is no evidence that adding niacin can cause any problems for a person already taking a statin. The report openly questioned why some prescribing instructions mention the possibility of adverse side-effect of combining niacin and statins when there are no documented reports of such side-effects. Any stories of such adverse side-effects almost certainly would have to occurred when a patient was taking "Sustain-release" niacin. "Sustain-release" niacin has a well-documented history of causing liver problems (mostly temporary and not serious). The form of niacin that is used in "Advicor" has been well-studied and is an "Extended-release" type (called "Niaspan"). It is very important that your husband use the prescription Niaspan type of niacin and not buy and over-the-counter type of niacin. (Over-the-counter "medicines", supplements and vitamins are not regulated and do not need to be proven safe or effective.)
If you feel that your cardiologist is experienced and knowledgeable in the treatment of cholesterol, then you can probably feel confident that his recommendations should be safe and effective.
The only issue I might raise is that niacin is often better tolerated when it is started at a lower dose, like 500 mg a day, and then increased after a week or so. Ask his doctor about niacin and how to reduce the flushing effect niacin can cause and if starting on 500 mg may be better tolerated. Go to this website to learn more about niacin and flushing: http://www.niaspan.com/Niaspan_Flushing/index.asp
Again, I love the combination of statins and niacin. This combination has been shown to be more effective at improving cholesterol levels and reducing the risk of heart attack, stroke, cardiac death and the need for angioplasty/bypass surgery by 89%. The statin niacin combination is more effective than the sum of its parts. This means that if statins are a "1" in effectiveness and niacin is a "1" in effectiveness, then the combination is a "3" (1 1=3).
I would encourage you and your husband to work closely with your doctor and try make the niacin work. This combination is the only medical treatment that has been proven to stop, or even slightly reverse, the advancement of heart disease.
