Lower Cholesterol Safely
Nutritional Interventions for Healthy Lipids
By Robert Haas, MS

Are statin drugs right for you?
At Life Extension®, we have long maintained that one’s decision to take a particular drug should be based on individual blood test findings.

For blood lipids, we recommend members seek to achieve the following optimal ranges:

Total cholesterol 160-180 mg/dL
LDL 50-99 mg/dL
HDL 50-60 mg/dL (and higher)
Triglycerides Under 80 mg/dL
Statin drugs lower LDL and total cholesterol, but have only a modest effect on boosting artery-cleansing HDL. Statin drugs do not lower triglycerides.

Physicians often rely solely on high-dose statin drug therapy to achieve desired blood lipid readings. One problem with this approach is that side effects elevate markedly as the dose of the statin drug is increased.

While you should take all necessary steps to protect heart health—which may include cholesterol-lowering medications—high-dose statins are often unnecessary. They should not be considered the only approach, given their considerable risks at high doses. The side effects of sustained statin use are well documented—muscle wasting, cognitive impairment, blurred vision, and nerve damage, among others.

Lower Cholesterol Safely
The encouraging news is that safe, low-cost, broad-spectrum interventions exist right now, especially for individuals with elevated cholesterol, LDL, and triglyceride levels (and low HDL) who do not have other risk factors for vascular disease.

In this article, we explore a novel set of natural lipid-lowering compounds shown to support healthy cholesterol levels. Monacolin-K, a compound found in standardized red yeast rice extract, is a naturally occurring statin. It may surprise you to learn that in clinical studies, red yeast rice along with healthy lifestyle practices lowers cholesterol as effectively as the prescription drug simvastatin.1

A substantial body of supportive research further indicates that monacolin-K also reduces triglycerides and boosts HDL, thus offering a safer and broader spectrum alternative to taking synthetic prescription statins.2-8

You will also discover the clinically demonstrated heart-protective benefits of other natural compounds that can bring your blood lipids into healthy balance, lower C-reactive protein (CRP) in the blood, quell chronic system-wide inflammation, and support healthy endothelial function.

Together they provide a potent, complementary alternative to prescription statin drugs.

Why So Many Doctors Advocate Statin Use
The simple answer is: many of them have been misled by Big Pharma. It’s no exaggeration to say that statins have become the new aspirin in mainstream medicine’s war on cardiovascular disease. They’re considered wonder drugs by many in the medical community. As one leading cardiologist observed, “You can’t go to a cardiology conference and ask who’s on statins without everyone’s hand going up.”9

Why So Many Doctors Advocate Statin Use
This almost casual attitude toward statin drug use largely stems from industry influence. Not content with letting doctors decide whether or not to prescribe statins on the merits of questionably favorable research data, some drug companies have apparently taken to bribing physcians to push statins on their patients. A 2009 investigative report disclosed that Pfizer and AstraZeneca, pharmaceutical giants that make the two best-selling statins—Lipitor® and Crestor®, respectively—offered Canadian doctors $100 for every new patient they put on the cholesterol-lowering drugs.10 This outrageous marketing ploy is nothing new. In 2003, when AstraZeneca was poised to launch Crestor®, which was already known to have twice the adverse side effects of other statins, another unethical deceit was discovered. Dr. Bryan Brewer, a highly influential cholesterol researcher, raved about the drug, telling attendants at a seminar at an American Health Association convention that the drug was safe and effective. His comments were conveniently published in a “special supplement” of the American Journal of Cardiology, timed perfectly with the release of Crestor® to the US market.11

An investigation later revealed that Dr. Brewer had financial ties to AstraZeneca as a paid speaker. It also revealed that AstraZeneca directly financed Dr. Brewer’s American Health Association seminar and Circulation’s special supplement. Dr. Brewer’s monetary ties to the drug maker were not disclosed in his article.

Red Yeast Rice: A Better Alternative to Statins
Red yeast rice (RYR), a staple of Chinese medicine and a traditional Asian seasoning, is made by fermenting polished rice with various strains of the yeast monacus purpureus. It contains a naturally occurring statin called monacolin-K.

High-dose statins are often unnecessary, and may not be the right choice for millions of people, given their side effect profile.
Monacolin-K effectively lowers cholesterol by acting as an HMG-CoA reductase inhibitor—the same mode of action as synthetic statin drugs. Bioactive compounds found in RYR complement monacolin-K’s lipid-lowering effects, including unsaturated fats.12 These act both as cholesterol-lowering and anti-inflammatory agents.13

Pantethine: A Lipid-Lowering Vitamin
Mainstream medicine has been slow to embrace red yeast rice (RYR) as an alternative treatment therapy because the FDA does not regulate the supplement—and because many doctors remain unaware of its lipid-lowering ability and safety profile. This constitutes a great disservice to the millions of Americans now taking synthetic statin drugs. There is a wealth of compelling evidence indicating RYR’s power to lower low-density lipoprotein (LDL) and triglyceride levels and raise high-density lipoprotein (HDL)—without unwanted and sometimes dangerous side effects.

In one of the largest studies of its kind, a meta-analysis of 93 randomized controlled trials involving almost 10,000 Chinese patients found that RYR could significantly lower levels of total cholesterol, LDL, and triglycerides, and raise levels of HDL compared with placebo.14

In a study specifically designed to determine if RYR could lower lipid levels without causing myalgias (muscle pain), researchers conducted a randomized, double-blind, placebo-controlled trial in patients with high cholesterol.15 Study participants were randomly assigned to take either 1,800 mg of red yeast rice or placebo twice daily for 24 weeks. All participants were also enrolled in a 12-week therapeutic lifestyle change program during the study.

WHAT YOU NEED TO KNOW: RED YEAST RICE

Cholesterol-lowering statin drugs are one of the most widely prescribed classes of drugs.
While protecting heart health is an important lifelong habit, the long-term effects of high-dose statin drugs carry considerable risks and should not be taken without thoughtful consideration.
Safe, low-cost interventions are available now for those seeking to safeguard heart health.
Red yeast rice contains monacolin-K, which works by the same mechanism as statin drugs to lower cholesterol.
Red yeast rice has been shown to lower LDL, total cholesterol, and triglycerides while raising HDL. Red yeast rice has even benefitted individuals who could not tolerate the side effects of statin drugs.
Since red yeast rice works similarly to statin drugs, practitioners recommend consuming extra CoQ10 while using it.
Other therapies that support healthy cholesterol levels include beta-sitosterol, pantethine, policosanol, and niacin.
LDL levels decreased more in the RYR treatment group (average decrease of 35 mg/dL) than in participants receiving the placebo (average placebo decrease was 15 mg/dL). The RYR treatment achieved these results without increasing muscle pain or CPK (creatine phosphokinase)—an enzyme in the blood that indicates muscle damage.

RYR has been shown in some studies to perform as well or better than some widely used synthetic statins. In one randomized, open-label clinical trial, investigators looked at 74 individuals with high cholesterol, dividing them between a simvastatin treatment group (40 mg/day) and an alternative treatment (AT) group.1

Risks of Statin Drugs
The alternative treatment included lifestyle changes and ingestion of RYR and fish oil supplements for 12 weeks; the statin group received their medication and traditional counseling. Both groups achieved a statistically significant reduction in LDL levels (AT group –42.4% and the simvastatin group –39.6%). But the AT group also achieved significant reductions in triglycerides (–29% in the AT group vs. –9.3% in the statin group) and weight loss (–5.5% vs. –0.4% of body weight in the statin group). The data showed that lifestyle changes (i.e., diet, exercise, relaxation techniques) combined with ingestion of RYR and fish oil reduced LDL in proportions similar to standard therapy with simvastatin. Investigators concluded that, “This multifactorial, alternative approach to lipid lowering has promise for a subset of patients unwilling or unable to take statins.”

Individuals already suffering from coronary heart disease (CHD) may also benefit from RYR as it has been shown to blunt the increase in triglycerides following a meal in patients with clinically documented coronary heart disease (CHD).16 After a high-fat meal, RYR significantly reduced fasting serum lipids while increasing fasting HDL. Post-meal triglyceride levels fell by 43% after 6 hours in the treatment group—but not in the control group.

Pantethine: A Lipid-Lowering Vitamin
Pantethine is the active form of vitamin B5 (or pantothenic acid), the molecule used to make coenzyme A (CoA). CoA is involved in the transport, synthesis, and oxidation of fatty acids to and from the cells, and into the mitochondria. As a member of the B-complex family of vitamins, pantothenic acid is essential to numerous bodily functions, including

synthesis of neurotransmitters, hormones, and hemoglobin. Studies have shown that pantethine can reduce serum triglycerides and cholesterol levels while increasing HDL levels. This is true across a broad range of at-risk populations.

Cardiovascular diseases are the main cause of death in women, especially post-menopause. In a 16-week study of 24 menopausal women with high cholesterol (total cholesterol greater than or equal to 240 mg/dL), pantethine yielded significant reductions of total cholesterol, LDL, and LDL/HDL ratio.17

Another study of pantethine in 7 children and 65 adults with high cholesterol and/or high triglycerides showed a significant reduction in total cholesterol, LDL, and triglycerides—as well as a substantial increase in HDL.18

RISKS OF STATIN DRUGS

Using prescription statins is not without serious health risks and no one knows the long-term effects of living on them for life, which is how they must be taken. People who use them and then quit a year later face elevated risk levels of stroke and heart attack.34,35 Many people who take statins have to stop because of muscle pain, the most commonly reported side effect.36,37 A serious and potentially fatal type of rhabdomyolysis (muscle breakdown) has also been reported in statin users.38-41

Numerous published studies have documented other hazards of taking statin drugs that afflict an untold number of users, including muscle damage,42 cognitive impairment,43 vision problems,44 peripheral neuropathy,45-47 and tendonopathy.48

Published surveys reveal that doctors tend to deny or to minimize statin risks to their patients. These denials occur even when patients present with symptoms that are well-documented adverse reactions to statin drugs, such as muscle pain and detrimental changes in memory, concentration, and mood.49

In another illustrative clinical trial, researchers examined the effect of oral treatment with pantethine on 20 patients with elevated cholesterol and triglycerides.19 They found significant decreases of total cholesterol, LDL, and triglycerides, with increased levels of HDL.

Beta-Sitosterol: An Anti-Inflammatory and Anti-Cholesterol Plant Extract
Beta-sitosterol is a primary plant sterol. This class of compounds is molecularly similar to cholesterol and may inhibit cholesterol’s absorption in the lower intestine and reduce levels of cholesterol in the blood. Phytosterols have also been shown to act in synergy with red yeast rice by achieving a therapeutic effect at a lower dose.

In effect, beta-sitosterol acts as a potent dietary cholesterol blocker. A significant body of clinical evidence has demonstrated its cholesterol-lowering effects. In a 2005 study, researchers gave 29 individuals with high cholesterol (40-80 years old, average age = 55; 14 with type 2 diabetes) an edible beta-sitosterol spread.20 Both diabetic and non-diabetic patients experienced a greater reduction in LDL—27% and 15% respectively—than controls.

A meta-analysis of 14 randomized controlled trials investigated the effects of plant sterols added to margarine on cholesterol levels.21 The sterol-fortified margarine caused a reduction in the mean concentration of LDL, an effect that tended to increase with age.

The results of two older beta-sitosterol studies further indicate it can decrease systemic inflammation. In one meta-analysis, the lead investigator noted that beta-sitosterol appears to support proliferation of peripheral blood lymphocytes and enhance the cytotoxic effect of natural killer cells.22 Another study that measured inflammation and immune suppression in marathon runners found that beta-sitosterol could help prevent immune system suppression and could reduce bodily inflammation.23 Together, these anti-inflammatory properties led researchers to suggest that beta-sitosterol might be of clinical use in treating a number of chronic inflammatory conditions that could lead to cancers of the breast and colon.

Policosanol
Policosanol is a naturally occurring component of beeswax and whole sugar cane. More than 80 studies performed mostly by a single research institute suggest that policosanol obtained from Cuban sugar cane at doses of 5-40 mg/dL exerts cholesterol-lowering effects equivalent to that of statin drugs.24,25 (It should be noted that other research groups using policosanol from alternative sources have failed to reproduce the efficacy of these alcohols observed in earlier studies.)26

Numerous animal models studies have been conducted using policosanol. One study found that pretreatment with policosanol and omega-3 fatty acids prevented arterial wall thickening and endothelial damage in animals whose arteries had been damaged artificially.27

Some research suggests that policosanol is effective in lowering cholesterol in patients with progressive atherosclerosis and diabetes. One study tested policosanol in patients suffering ischemic stroke who were also treated with aspirin and vitamins. They achieved substantially positive results, with improvements in neurological outcomes and recurrent events.28

Niacin
Niacin’s ability to lower LDL, raise HDL, and lower triglyceride levels has been conclusively established by a wealth of clinical research.29 It is one of the best-known and most widely used vitamins for lowering blood cholesterol levels. It has also been shown in multiple studies to provide better heart health protection than some statins. A widely publicized study appearing last November in the New England Journal of Medicine found that niacin was more effective at shrinking artery plaque than a billion-dollar blockbuster called ezetimibe, the active ingredient in the cholesterol drugs Zetia® and Vytorin®.30

RED YEAST RICE PRECAUTIONS

Let your doctor know if you decide to take red yeast rice extract. Use it only under the guidance and supervision of your doctor or a healthcare practitioner. Pregnant or breast-feeding women should check with a health care provider before using products that contain red yeast rice extract.

Due to the relative lack of regulation of supplement manufacture, the stated content of red yeast rice products is unpredictable unless you use a product with certified concentrations of standardized monacolin-K content.

We strongly recommend using only standardized red yeast rice extract from reputable manufacturers who routinely test their products for purity.

As with prescription statins, people who ingest high doses of red yeast rice extract can experience muscle pain.50-52

As is also the case with statins, use of red yeast rice products may also deplete tissue levels of CoQ10.53 Life Extension® recommends taking additional CoQ10 for those people who take statins and red yeast rice-containing products.

Recent studies further indicate that niacin reduces oxidative stress and inhibits vascular inflammatory genes, including key cytokines involved in atherosclerosis.29,31,32 Until recently, niacin’s general use and widespread patient tolerability have been impeded by the need to take it 4 times a day and by the high incidence of skin flushing, gastric problems, and other adverse events.

CoQ10 may boost heart health of diabetics on statins CoQ10 may boost heart health of diabetics on statins
A form of “no-flush” niacin has emerged, called inositol hexaniacinate (IHN).33 It consists of six molecules of nicotinic acid (niacin) and one molecule of inositol. It is metabolized in the body into its component parts, niacin and inositol, and does not reach maximum blood levels for approximately 10 hours after ingestion. This form of the vitamin has not been linked with the skin “flushing” or other typical niacin reactions, even when ingested in amounts typically associated with skin flushing, nausea, vomiting, and agitation. Regrettably, it also does not work as well as niacin in reducing LDL and triglycerides and boosting HDL.

Summary
Statin drugs are heavily used and over-prescribed, owing to industry influence and misinformation. High-dose statins are often unnecessary, and may not be the right choice for millions of people, given their side effect profile. Studies indicate that any reduced cardiovascular risk from taking statins may be offset by other serious side effects, from sexual, visual, hepatic, renal, and cognitive dysfunction to disability and death. Aging individuals who want to lower their blood lipid levels and C-reactive protein (CRP) number may be able to achieve similar benefits with standardized red yeast rice extract, beta-sitosterol, pantethine, policosanol, and niacin. These synergistic ingredients have been shown to reduce blood lipid levels while promoting healthy endothelial function and reducing CRP and systemic inflammation. They offer a safer alternative to taking synthetic prescription statins.

Using Niacin to Improve Cardiovascular Health
By William Davis, MD

Q: I recently had a cholesterol profile blood test and learned that I may be at risk of heart disease because my levels of beneficial HDL (high-density lipoprotein) are too low. I read that niacin could help increase my HDL, but my doctor said niacin is dangerous. Whom should I believe?

A: Your doctor would be right—if we were still living in 1985. Since then, however, we have learned how to use niacin (vitamin B3) safely and effectively. Unfortunately, many physicians have not yet caught up, or are still trapped by the idea that cholesterol-lowering statin drugs are the only way to decrease cardiovascular disease risk. I have personally prescribed niacin for thousands of patients as part of our program to reverse coronary disease. In fact, niacin is the closest thing we have available to a perfect treatment that corrects most of the causes of coronary heart disease.

Niacin, also known as “nicotinic acid,” is found in red meat, chicken, turkey, beans, and grains. It is a required nutrient and a member of the B vitamin family. Have you ever taken a B-complex vitamin pill that triggered a strange burning sensation of the skin? If so, that was the niacin you experienced. Niacin plays a crucial role in energy production, gene expression, and hormone synthesis. Humans cannot exist without it.

The recommended dietary allowance (RDA) of niacin to prevent pellagra (a disease caused by vitamin B3 deficiency and characterized by diarrhea, dermatitis, dementia, and possible death) is 16 mg a day for males and 14 mg for females. Pellagra induced by niacin deficiency was widespread in the United States during the nineteenth century, but is now long forgotten and rarely seen.

When taken at doses greater than the RDA, niacin confers an array of health benefits. Niacin:

Increases high-density lipoprotein (HDL) by 20-35%. No other available over-the-counter treatments, and very few drugs, are as effective.
Decreases small low-density lipoprotein (small LDL) particles. Small LDL is an important yet underappreciated cause of heart disease. Niacin is the most effective agent known for correcting this abnormal pattern.
Decreases triglycerides by 30%. Niacin is especially effective when taken with fish oil (at doses of 4000 mg a day, providing 1200 mg of EPA/DHA).
Decreases very low-density lipoprotein (VLDL) particles.
Decreases lipoprotein(a), or Lp(a). No other treatment approaches the power of niacin to reduce the genetically determined pattern of high Lp(a), which is among the most serious risk factors for heart disease.
Decreases low-density lipoprotein (LDL), usually by 20-40 mg/dL, or 5-25%.
Niacin blocks the release of fatty acids from fat cells. Fewer fatty acids are passed through to the liver, resulting in fewer VLDL particles. Less VLDL leads to less small LDL and higher HDL.1 Niacin also improves endothelial function and nitric oxide synthase activity.

Niacin’s benefits are not limited to its influence on blood markers of cardiovascular disease risk. It also reduces heart attack risk dramatically. The Coronary Drug Project was the first to establish that niacin is a powerful agent in lowering heart attack risk. When more than 1,000 heart attack survivors were given 3000 mg of (immediate-release/crystalline) niacin daily for six years, the incidence of recurrent non-fatal heart attacks was reduced by 27%, and the number of strokes was reduced by 26%.2

In the well-known HDL-Atherosclerosis Treatment Study (HATS), 160 participants were given niacin and simvastatin (Zocor®) or a placebo. Compared to the placebo group, the group receiving niacin and simvastatin experienced a 90% reduction in death and myocardial infarction over three years.3 In other words, coronary events were nearly eliminated. Although the study sample was small, its results are striking. By comparison, statin drugs alone typically reduce heart attack risk by 25-35%. The 90% reduction achieved in the HATS trial thus is truly remarkable.

Despite niacin’s track record, many physicians have never learned how to use it effectively. Statin drugs have caused many physicians to forget how effective niacin can be. This is a shame, because niacin can be a powerful agent in combating heart disease, when used alone or in combination with other treatments (especially fish oil).

Niacin’s safety record is equally impressive. However, a brief foray into the use of very-slow-release niacin preparations in the 1980s taught us an important lesson: niacin is very safe, if the liver is exposed to it for only a few hours at a time. Niacin is, after all, just vitamin B3. However, 24-hour, day-after-day exposure to niacin over an extended period can be toxic to the liver. Thus, the very-slow-release niacin preparations that yielded sustained, high blood levels of niacin caused liver toxicity in 10-20% of people who used these preparations in the 1980s. Unfortunately, this learning experience left some physicians fearful of recommending niacin to their patients. For this reason, very-slow-release niacin should be avoided.

There are two safe forms of niacin:

Immediate-release/crystalline niacin is available as a nutritional supplement and is inexpensive and effective. The niacin in each table is released immediately and usually provokes a “hot flush,” a warm, itchy feeling of the skin. For this reason, starting at small doses, such as 250 mg, can be helpful. The dose can be increased gradually (by 250 mg every four weeks) to achieve the desired amount. Doses greater than 500 mg per day should be used only under medical supervision. Some people take their niacin in small doses, three or four times daily, to spread out the dose. This could be unsafe, and I recommend that patients never take immediate-release niacin more than twice a day.
Extended-release niacin is a time-release preparation, but does not act as slowly as slow-release niacin. This makes it safer than the slow-release preparations that can cause liver side effects. Extended-release niacin also provokes fewer hot flushes than immediate-release niacin. An example is Slo-Niacin®, which is sold over the counter. Niaspan® is an extended-release niacin preparation sold as a prescription drug.
By contrast, slow-release niacin preparations reduce the hot-flush effect by releasing niacin over an extended period of 12 hours or longer. Most of these preparations are unsafe and I do not recommend them. “No-flush” niacin preparations, such as inositol hexaniacinate and nicotinamide, are widely sold as niacin alternatives that do not cause hot flushes. In my experience, however, they simply do not work. In other words, no flush, no effect.

The correct dose of niacin depends on what abnormality you and your doctor are trying to correct. To raise HDL and correct small LDL, a dose of 750-1000 mg a day usually provides full benefit. Increasing this dose to 1500 mg a day may provide slightly greater benefit. To reduce LDL or Lp(a), higher doses (from 1000 mg up to 4000-5000 mg per day) are often used, with higher doses providing greater effects. However, doses this high should be taken only with a physician’s supervision. Keep in mind that it may take three months or longer to realize the full lipid-optimizing benefits of niacin.

As previously noted, the one common though generally harmless side effect of taking niacin use is hot flushes. Some people find them bothersome enough that they want to flush the niacin down the toilet!

The flush, which feels like blushing when one is embarrassed, is usually accompanied by a prickly sensation over the face, neck, and chest. Some women say it feels like the hot flashes of menopause. These flushes are usually short-lived, lasting no more than 20 minutes. Tolerance to this effect occurs with continued niacin use, usually after a few weeks or months. You may experience flushing at the start of your niacin program as well as when you increase your dose. In rare cases, a more marked flushing reaction may occur, resembling a rash or hives. If this occurs, speak to your doctor about whether you should continue using niacin.

You can employ several strategies to greatly minimize or even eliminate niacin-induced hot flushes:

Drink plenty of water. This is very important and especially helpful when you experience a hot flush: drink two 8- to 12-ounce glasses of water immediately, and the hot flush will almost always disappear within a few minutes. If you need to drink water to block hot flushes but find yourself getting up several times a night to urinate, take your niacin with dinner or breakfast. If you are restricting your fluid intake because of kidney disease, heart disease, water retention, or diuretic use, talk with your doctor before increasing your water intake.

Take niacin after consuming a small handful of nuts, such as 5-10 raw almonds, walnuts, or pecans. This will slow niacin’s absorption in the body. You may want to skip this if you are limiting your calorie intake in order to lose weight. While some people recommend taking niacin with a low-fat snack, I discourage this approach, as low-fat snacks like crackers contribute to increased levels of dangerous small LDL.
Take niacin with an aspirin. When you start niacin and whenever you increase the dose, taking an adult (325-mg) uncoated aspirin tablet can block the niacin flush. After a few weeks or months, when flushing dissipates, changing to a low-dose (81-mg) enteric-coated aspirin can minimize stomach upset and the long-term risk of stomach ulcers and bleeding. Always discuss aspirin use with your doctor, and only use aspirin on a long-term basis with your doctor’s recommendation.
Avoid alcohol and spicy foods when taking niacin. This strategy is not crucial for everyone, as only some people are sensitive to this phenomenon. You can consume alcohol and spicy foods apart from your use of niacin—for example, having a glass of wine at 7 p.m. and then taking niacin at 9 p.m. Only a few people will have more flushing due to the combination.
Niacin may raise blood sugar by about 4-5 mg/dL at the beginning of therapy. This increase usually dissipates over a few months, and is rarely clinically important. However, increases in blood sugar may be greater if you already have high blood sugar or diabetes. For this reason, niacin should be taken under medical supervision, with gradual increases in dosage, if you have high blood sugar. Having diabetes or pre-diabetes is not necessarily a contraindication to niacin use. In fact, people with these conditions are most likely to benefit from niacin, since diabetes and pre-diabetes are strongly associated with small LDL, low HDL, increased triglycerides, and other abnormalities that are corrected by niacin.4 (Individuals with extremely high triglyceride levels of greater than 1000 mg/dL may require a combination of therapies to achieve effective lipid level control.) Type I (childhood-onset) diabetes, however, is often a contraindication to niacin use, as blood sugar is significantly elevated in this condition.

Niacin therapy should be initiated in patients with low HDL levels (less than 40 mg/dL for men and less than 50 mg/dL for women), particularly if other risk factors are present. Niacin is among the most effective agents known for correcting the multiple causes of heart and vascular disease, and has been shown to greatly diminish the risk of heart attack. Niacin is very safe and easy to use, if used properly. In my experience, over 95% of people who follow these guidelines are able to take niacin with only minimal hot flushes. Potentially serious side effects are almost never seen.

People with liver disease, unexplained elevation of liver enzymes, active peptic ulcer disease, or a history of abnormal bleeding should consult their physician before beginning niacin treatment. Those with a past history of liver disease, jaundice, peptic ulcer disease, gastritis, or alcoholism should exercise caution with niacin. Gout may flare up when niacin is used, so talk to your doctor if you have a history of gout.

Dr. William Davis is an author and cardiologist practicing in Milwaukee, Wisconsin. He is author of the book, Track Your Plaque: The only heart disease prevention program that shows you how to use the new heart scans to detect, track, and control coronary plaque. He can be contacted at www.trackyourplaque.com.

References
1. Carlson LA. Nicotinic acid: the broad-spectrum lipid drug. A 50th anniversary review. J Intern Med. 2005 Aug;258(2):94–114.

2. Canner PL, Berge KG, Wenger NK, et al. Fifteen year mortality in Coronary Drug Project patients: long-term benefit with niacin. J Am Coll Cardiol. 1986 Dec; 8(6):1245-55.

3. Brown BG, Zhao XQ, Chait A, et al. Simvastatin and niacin, antioxidant vitamins, or the combination for the prevention of coronary disease. N Engl J Med. 2001 Nov 29;345(22):1583–92.

4. McKenney J. New perspectives on the use of niacin in the treatment of lipid disorders. Arch Intern Med. 2004 Apr 12;164(7):697–705.