An Old Cholesterol Remedy Is New Again

By MICHAEL MASON
Published: January 23, 2007

Perhaps you heard it? The wail last month from the labs of heart researchers and the offices of Wall Street analysts?

Torcetrapib wasn’t just another scientific misfire; the drug was to have been a blockbuster heralding the transformation of cardiovascular care. Statin drugs like simvastatin (sold as Zocor) and atorvastatin (Lipitor) lower blood levels of LDL, the so-called bad cholesterol, thereby slowing the buildup of plaque in the arteries.

But torcetrapib worked primarily by increasing HDL, or good cholesterol. Among other functions, HDL carries dangerous forms of cholesterol from artery walls to the liver for excretion. The process, called reverse cholesterol transport, is thought to be crucial to preventing clogged arteries.

Many scientists still believe that a statin combined with a drug that raises HDL would mark a significant advance in the treatment of heart disease. But for patients now at high risk of heart attack or stroke, the news is better than it sounds. An effective HDL booster already exists.

It is niacin, the ordinary B vitamin.

In its therapeutic form, nicotinic acid, niacin can increase HDL as much as 35 percent when taken in high doses, usually about 2,000 milligrams per day. It also lowers LDL, though not as sharply as statins do, and it has been shown to reduce serum levels of artery-clogging triglycerides as much as 50 percent. Its principal side effect is an irritating flush caused by the vitamin’s dilation of blood vessels.

Actually, I like that irritating flush. After awhile, with regular niacin usage, the flush goes away, and it's usually very easy to manage if you start at low amounts and gradually work up to the higher amounts. Talk to a trusted health care provider if you're uncertain about real niacin.