Question: I’m thinking about taking niacin for my heart condition, but have heard that it may be risky. What do you think?
Dr. Hibberd's answer:
Niacin is no longer the preferred agent for cholesterol control for most patients. Today, I generally avoid using niacin products due to side effects and tolerance problems. Current guidelines have been updated to reflect management of lipid disorders with dietary adjustments, along with drug management in those needing a statin to control their risks.
Statins are now the preferred agent, though a pure fish oil product (such as prescription Lovaza) in doses of one to two grams twice daily are often added as a reasonable addition to control triglycerides as well as to reduce cardiac risk especially in those who have had vascular problems.
Our use of niacin has been de-emphasized, mainly because of concerns about negative interactions with statins as well as adverse effects on glucose control, and other problems. In addition, there has been an increase incidence of rhabdomyolysis — a serious life-threatening side effect where levels of CPK (a muscle enzyme) rise to toxic levels causing renal failure.
The use of other agents such as Zetia, fibrates, and Gemfibrozol have also been de-emphasized, as studies of these products have questioned their benefits.
I usually avoid using niacin products given the far greater safety and effectiveness of other products, such as newer statins like Crestor, that are available today.
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