Fifteen year mortality in Coronary Drug Project patients: Long-term benefit with niacin

Abstract

The Coronary Drug Project was conducted between 1966 and 1975 to assess the long-term efficacy and safety of five lipid-influencing drugs in 8,341 men aged 30 to 64 years with electrocardiogram-documented previous myocardial infarction. The two estrogen regimens and dextrothyroxine were discontinued early because of adverse effects. No evidence of efficacy was found for the clofibrate treatment. Niacin treatment showed modest benefit in decreasing definite nonfatal recurrent myocardial infarction but did not decrease total mortality. With a mean follow-up of 15 years, nearly 9 years after termination of the trial, mortality from all causes in each of the drug groups, except for niacin, was similar to that in the placebo group. Mortality in the niacin group was 11% lower than in the placebo group (52.0 versus 58.2%; p = 0.0004). This late benefit of niacin, occurring after discontinuation of the drug, may be a result of a translation into a mortality benefit over subsequent years of the early favorable effect of niacin in decreasing nonfatal reinfarction or a result of the cholesterol-lowering effect of niacin, or both.

Antioxidant Supplements Block the Response of HDL to Simvastatin-Niacin Therapy in Patients With Coronary Artery Disease and Low HDL

“…16 Based on these observations and current concepts of the antiatherogenic roles of HDL in promoting reverse cholesterol transport 17 and as an antioxidant, 18 several treatment strategies for CAD patients with low HDL have been proposed. They include (1) raising HDL with weight loss, exercise, diet, and smoking cessation (lifestyle modification); (2) increasing the HDL to LDL ratio with niacin and a statin; (3) inhibiting LDL oxidation and atherogenesis with antioxidants; and (4) improving both the lipid profile and antioxidant status with a combination of niacin, a statin, and antioxidant therapy. We have recently completed a clinical trial on the effect of these 4 interventions on coronary artery stenosis and clinical outcomes.…”

The role of vitamins in the diet of the elderly II. Water-soluble vitamins

“…It has now become clear that an increased quantity of vitamin B 3 increases the high-density lipoprotein level (HDL) in the serum, reduces triglyceride and lipoprotein(a) levels, and -to a lesser degree -reduces the level of low-density lipoprotein (LDL) as well as the total amount of cholesterol (Brown et al, 2001). When administered alone, vitamin B 3 reduced the rate of cardiovascular diseases (Canner et al, 1986). Medication aimed at reducing LDL cholesterol level is more efficient if administered along vitamin B 3 .…”

Niacin requirements for genomic stability

“…Unfortunately, there is almost nothing in the literature about cancer risk or long-term all cause mortality in these populations. In one long term study, nine years after the end of a 6 year niacin intervention, the group that had been on the niacin treatment showed improvement in all-cause mortality [63]. Another weakness in the literature is in the area of niacin status and skin cancer risk.…”