Dose of extended-release niacin, 2000 mg in 75%, 1500 mg in 3%, 1000 mg in 12%, 500 mg in 10%

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Thursday, November 19, 2009 12:28 pm Email this article
There were fewer heart attacks, fewer heart bypasses performed, fewer cardiovascular deaths, and fewer total deaths during a 14 month period in statin users given extended-release niacin compared to those given Zetia (ezetimibe) according to a study published in the New England Journal of Medicine.

The final dose of extended-release niacin was:

• 2000 mg in 75% of patients


• 1500 mg in 3% of patients


• 1000 mg in 12% of patients


• 500 mg in 10% of patients

In rare cases, niacin can cause liver problems.

This is more common with extended-release niacin than regular niacin.

This is because extended-release niacin (or time-release niacin) is roughly the equivalent of double the dose of regular niacin as noted by Dr. William Parsons in the 1993 book Coronary Heart Disease: The Dietary Sense and Nonsense. An evaluation by scientists. Niacin Dose

Niacin dose: 2000 mg of extended-release niacin at bedtime

The dose of niacin was 2000 mg of extended-release niacin given at bedtime.

Niacin was started at 500 mg for two weeks, then 1000 mg for two weeks, then 1500 mg for two weeks, then 2000 mg.

 

Extended-release Niacin vs Regular Niacin

A dose of extended-release niacin is roughly equal to twice the dose of regular niacin

Here is a quote about regular niacin versus extended-release niacin from the 1993 book Coronary Heart Disease: The Dietary Sense and Nonsense. An evaluation by scientists in Chapter 8 titled “Clinical Alternatives” written by William B. Parsons, Jr, MD.

“Playing niacin, in doses of [3000 mg] per day is usually quite safe, and the plain form seldom causes problems in doses up to [6000 mg] per day.

“The relatively few reports of [liver] toxicity in recent years have usually occurred when a patient, physician, or pharmacist has not realized that substituting time-release niacin for plain niacin and equal dosage is the approximate equivalent of doubling the dose.

“The fact that [liver] function alterations are more frequent with the time-release preparations has been recognized since the early 1960s.

“The number of reported cases of [liver] toxicity has been relatively small, especially considering the greatly increased interest since publication of the [ National Cholesterol Education Program] guidelines in 1988.”

—William B. Parsons, Jr, MD

 

Patients Age

Average age 65, all with cardiovascular disease

All patients had cardiovascular disease or were considered high-risk.

On average, patients were 65-years-old.

Eighty percent (80%) were men.

 

Patients Taking a Statin

All patients had been taking a statin

All were taking a statin, the average time having taking a statin was 6-years.

 

95% on Zocor or Lipitor

95% of patients were taking either Zocor (simvastatin) or Lipitor (atorvastatin)

Ninety-five percent (95%) of patients were taking either Zocor (simvastatin) or Lipitor (atorvastatin).

The average dose was 42 mg per day.

Cholesterol and triglyceride levels at the start of the study were:

• 146 mg per deciliter for Total Cholesterol
• 82 mg per deciliter for LDL Cholesterol
• 42 mg per deciliter for HDL Cholesterol
• 137 mg per deciliter for Triglycerides

The baseline level of total cholesterol was 146.1±23.6 mg per deciliter (3.8±0.7 mmol per liter); LDL cholesterol, 82.1±23.1 mg per deciliter (2.1±0.6 mmol per liter); HDL cholesterol, 42.4±8.5 mg per deciliter (1.1±0.2 mmol per liter); and triglycerides, 137±67 mg per deciliter (2±1 mmol per liter).

 

Study Terminated Early

Study terminated early because niacin was so superior to Zetia

The study was terminated early, after 14 months, because niacin was so superior to Zetia (ezetimibe).

 

Zetia Accelerated Atherosclerosis

Zetia cause an acceleration of atherosclerosis even though it lowered LDL

The also measured thickness of the carotid artery wall to try and determine if either of these agents caused regression of atherosclerosis.

“Paradoxically, greater reductions in the LDL cholesterol level in association with ezetimibe [Zetia] were significantly associated with an increase in” thickness of the carotid artery wall.

In other words, although Zetia (ezetimibe) reduced LDL cholesterol, it made the problem worse.

It cause an acceleration of atherosclerosis.

But that’s not all.

 

Worsening of Atherosclerosis Greater

The acceleration of atherosclerosis seen in the Zetia group was worse in those whose LDL was lowered the most

The more Zetia (ezetimibe) lowered LDL cholesterol, the worse the problem got.

 

This was NOT the case with Niacin

This was NOT the case with niacin

This was not the case with niacin.

Here is the quote from the paper talking about this.

“There was a significant inverse relationship between the changes in LDL cholesterol level and the carotid intima–media thickness in the ezetimibe group, such that a paradoxical increase in the carotid intima–media thickness was seen in patients [given Zetia] with greater reductions in LDL cholesterol. Such a relationship was not observed in the niacin group.”

 

How A Drug Affects Your Risk of Death Is The ONLY Thing That Matters

Do not be fooled by a drugs effects on markers such as LDL, blood pressure or blood sugar

Do not be mislead by whether or not a drug lowers LDL cholesterol, or blood pressure, or blood sugar.

Studies going back as far as the early-1970’s found that while oral diabetes medicines lower blood sugar levels, they cause more problems than they solve.

Data from a 2004 study by Sylvia Wassertheil-Smoller, PhD from the Albert Einstein College of Medicine revealed that older women with “hypertension” who were given blood pressure drugs were more likely to die of cardiovascular disease in seven out of the eight drug groups compared to “hypertensive” women who were taking no blood pressure medicines at all even though systolic pressure in the drug groups was 10-15 points lower than in the non-drug group.

Yes, really.

The articles are posted here

So do not be fooled by how a drug affects a marker like LDL cholesterol, or blood pressure, or blood sugar.

The only thing that matters is whether or not it lowers your total risk of death.

REFERENCE

Taylor AJ, Villines TC, Stanek EJ, Devine PJ, Griffen L, Miller M, Weissman NJ, Turco M. Extended-release niacin or ezetimibe and carotid intima–media thickness. N Engl J Med. Published at http://www.nejm.org November 15, 2009, published early on-line.

AUTHOR’S CONTACT INFORMATION

Dr. Allen Taylor
Department of Medicine (Cardiology)
Medstar Research Institute
Washington Hospital Center
110 Irving St. NW, Rm. 1E12
Washington, DC 20010
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Articles on the same subject can be found here:

• Cholesterol

• Cholesterol drugs

• Heart Disease

• Natural Treatments

• Niacin (vitamin B3)

• Zetia (ezetimibe)