Vitamin B3, or niacin, is often used in patients with too much cholesterol. Supposed to prevent strokes or heart attacks, it is in fact ineffective.
An “unacceptable treatment” for patients at risk for a cardiovascular event. Niacin, or vitamin B3, has long been used to prevent stroke and myocardial infarction in parents with high cholesterol levels. Wrongly, if we are to believe a study and an editorial published this July 17 in the prestigious New England Journal of Medicine : such a treatment would entail more risks than benefits.
9% increased risk of death
Niacin or laropiprant (which contains niacin) has been used for 50 years in patients at cardiovascular risk. But studies to the detriment of such a therapeutic option are piling up. The latest sparked a heated reaction from Dr Donald Lloyd-Jones, a chair in preventive medicine at the Feinberg School of Medicine at Northwestern University. “There is one more death for every 200 people who are put on niacin. In view of such signals, it is an unacceptable treatment for the vast majority of patients, ”insists Dr. Donald Lloyd-Jones. “For reducing the risk of heart disease or stroke, statins remain by far the most important strategy, thanks to their proven benefits and safety. “
At the origin of this editorial, a study conducted among more than 25,600 people on statins and at cardiovascular risk. Some took niacin or laropiprant, others a placebo. Vitamin B3 not only does not reduce the risk of heart attack or stroke, it also increases the risk of death by 9%. Not to mention the many side effects highlighted: liver problems, infections, heavy bleeding, gout, irregular blood sugar levels in diabetics, and even the occurrence of diabetes in healthy patients at the start of the study.
No effect on cardiovascular risk
On paper, however, niacin seems providential: it increases “good” cholesterol (HDL) and slightly reduces “bad” (LDL) as well as triglycerides. But no clinical trial has succeeded in demonstrating a preventive effect of vitamin B3. This latest study shows that in fact, it is a high level of HDL that is protective. Artificially increasing it with medication has no effect. “Recent clinical trials with niacin prove once again that raising levels of ‘good’ cholesterol in addition to statin therapy is not delivering the positive results we were hoping for. Reducing ‘bad’ cholesterol with optimal intensity of statins tolerated, in addition to changes to a healthy lifestyle, remains the most effective approach to prevent stroke or heart attack in patients at risk, ”concludes Dr. Neil Stone, who conducted the study.
Under these conditions, the prescription of niacin should be reserved for patients at very high risk of stroke or heart attack, who cannot be placed on statins and for whom no other treatment option is possible, believes Dr. Donald Lloyd-Jones.
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