AHA: Niacin Bests Ezetimibe
Boosting HDL cholesterol with extended-release niacin (Niaspan) is a more effective way of slowing atherosclerosis in high-risk patients on long-term statin therapy than seeking additional LDL cholesterol reductions by adding ezetimibe (Zetia), researchers here reported.Anthony DeMaria, MD, Editor-in-Chief of the Journal of the American College of Cardiology, noted that "this is a small trial with a small number of cardiovascular events."...
"This trial doesn't quite put the nail in the coffin for ezetimibe, but it pushes it way down on the list of medications for cholesterol-lowering therapy," he said.
Jim Stein, MD, of the Medical College of Wisconsin, had even stronger advice for colleagues:
"Doctors need to stop using so much ezetimibe. Using this drug is not practicing evidence-based medicine. It is taking a path of least resistance -- the easy way out of getting numbers to targets. But we don't treat numbers, we treat patients, and are obligated to use drugs that are proven in clinical trials to reduce things they care about -- heart attacks, strokes, and death -- and to do so safely."...
READ COMPLETE ARTICLEPrimary source: http://content.nejm.org/cgi/content/full/NEJMoa0907569
AP report
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Originally posted September 2007
If vitamins don't help you why this?
Imagine this: a patent on a common B vitamin known for a very long time to reduce your cholesterol. Health freedom fighters have been warning of vitamin control almost as long as B3 has safely reduced your cholesterol, raised HDL, reduced LDL and those deadly triglycerides.
Merck wants you to shell out big bucks for their new drug under the guise of an added chemical that will "inhibit an often intolerable niacin side effect called flushing".
They don't tell you that there is a form or two of niacin (B3) that does not cause flushing, nor do they tell you that the flushing is an indicator that the benefit of B3 is actually doing something to benefit your health when you experience the flushing.
Niacinamide is one form of niacin that is "flush-free". You do have to take higher amounts of this form and it may take longer to get the desired result.
Inositol hexanicotinate is a second option which promotes liver health and achieves LDL reduction.
You might get either of these starting at $8.00 - $12.00.
And in case you want that tingly niacin, start out with 100 mg. tablets and work up slowly to a higher, more therapeutic dose over time. This is usually what I suggest and it gives your body a better chance to adapt to the changes forthcoming.
Not sure what enormous amount Merck plans to market this new product for but you can bet it won't be inexpensive. (The cost of 500 mg dosage of Niaspan is $25.97 for 30 capsules. Note that the chemicals required to allow for extended release have been reported to be problematic, so I'd opt for just plain B3)
Merck niacin drug controls cholesterolSee http://naturalhealthnews.blogspot.com/2009/08/arthritis-drugs-pose-cancer-risk.html
By LINDA A. JOHNSON, AP Business Writer2 hours, 11 minutes agoAn experimental cholesterol treatment touted by drugmaker Merck & Co. significantly reduced artery-clogging fats in late-stage testing, but it got a mixed reception from Wall Street analysts Tuesday.
The drug, called Cordaptive, can both raise good cholesterol and lower bad cholesterol. It combines an extended-release form of the B vitamin niacin with a chemical to inhibit an often intolerable niacin side effect called flushing — redness, burning and tingling of the face.
At a European cardiology conference Sunday, Merck for the first time reported results of a major study of Cordaptive. The 24-week study, which included about 1,600 patients, found that compared with dummy pills, Cordaptive produced an 18 percent drop in levels of LDL-C, or "bad" cholesterol; a 26 percent drop in another type of blood fat called triglycerides, and a 20 percent increase in levels of HDL-C, or "good" cholesterol.
Those results were about the same whether or not patients were also taking cholesterol-lowering drugs called statins. Among study patients taking Cordaptive, 29 percent had moderate flushing or worse, versus 56 percent of patients taking just extended-release niacin and 6 percent of those taking a dummy pill.
Analyst Steve Brozak of WBB Securities said the safety profile for Cordaptive, which is awaiting Food and Drug Administration approval, wasn't perfect but is "not problematic."
"I think that the FDA will be predisposed to approve it," Brozak said, given the many people with heart disease or uncontrolled cholesterol, which contributes to hardening of the arteries.
Joseph Tooley, an analyst at A.G. Edwards Pharmaceutical Group, wrote that Cordaptive appears as safe as niacin and that its reduced flushing differentiates it from existing products.
But Cowen and Co. analyst Steve Scala wrote that Cordaptive's safety profile "trended less favorably" than extended-release niacin, with measures of substances in the blood that can indicate potential liver damage, muscle damage and blood-sugar problems a little worse for Cordaptive than the extended-release niacin.
"We think there's no difference between those, especially given the size of the trial," responded Dr. John Paolini, head of the Cordaptive product development team at Merck. "Most importantly, there were no cases of hepatitis" or symptoms of liver damage in the patients.
Any worrisome changes in blood levels of enzymes were temporary and ended when patients stopped taking Cordaptive, he said.
Niacin has been used to control cholesterol for decades, and an extended release version, called Niaspan, has been on sale for years. The flushing problem, however, has prevented many patients from reaching the most effective dose and caused many others to stop taking niacin or Niaspan altogether, Paolini said in a telephone interview from the conference in Vienna.
In a statement Tuesday, Abbott Labs, maker of Niaspan, countered that facial flushing is generally a temporary side effect, which can be easily managed with aspirin.
Cordaptive would beef up Merck's cholesterol franchise, a key area because its statin drug Zocor, which had been Merck's top seller, has seen sales plunge since it got generic competition a year ago. Merck and partner Schering-Plough Corp. jointly market two other cholesterol drugs, Zetia and Vytorin.
Scala forecast $150 million in Cordaptive sales in 2008, with revenue growing to $700 million in 2012. Banc of America Securities analyst Chris Schott predicted $665 million in 2011 sales.
Morgan Stanley analyst Jami Rubin agreed that sales could top $700 million by 2011, but noted that Abbott Labs is developing a concentrated version of its niacin drug.
Merck shares fell 13 cents to $50.04 in trading Tuesday.
