Taking one drug to boost "good" cholesterol and another to lower its evil twin can slow the progression of heart disease more effectively than one medicine alone, the first study to test this dual approach has found.
The added benefits came from taking niacin, a type of B vitamin, on top of statins, the cholesterol-lowering drugs prescribed to millions of Americans and sold under such brand names as Lipitor and Zocor.
"This ushers in a new era of taking a two-pronged approach" to controlling cholesterol, said the study's leader, Dr. Allen Taylor, director of Cardiovascular Research for the Cardiology Service of the Walter Reed Army Medical Center.
Separately, other research found that supplements of a different nutrient, vitamin E, not only didn't help heart disease but actually seemed to make it worse.
"People take vitamin E because they think it's going to make them live longer. This doesn't support that at all," said Dr. Edgar Miller of Johns Hopkins University, who led the analysis.
Both studies were reported Wednesday at an American Heart Association conference in New Orleans. The niacin one also was published in Circulation, the heart association's medical journal.
Doctors said the niacin research could give them an entirely new way to treat high cholesterol, a major risk factor for heart disease, strokes and other problems.
LDL, or "bad" cholesterol, has long been the focus of their efforts, and the ability of statin drugs to drop it almost overnight has made them the best-selling medications in America.
But attention increasingly is turning to HDL, or "good" cholesterol, which helps remove fats from the blood. Some research suggests it may matter as much as or even more than LDL in heart disease risk, and several companies are rushing to develop HDL-raising medications.
For decades doctors have known that niacin can do this, but it causes a prickly hot sensation called "flushing" that many people find unbearable.
The new study used Niaspan, an extended-release, prescription niacin that causes less flushing. Its maker, Kos Pharmaceuticals, funded the work along with the Jackson Foundation for the Advancement of Military Medicine.
The experiment involved 149 people who had suffered a heart attack or had other signs of hardened arteries, such as chronic chest pain. All had been on a statin drug for an average of 4½ years. Their LDL averaged 89, well below the recommended 100 upper limit, but their HDL was around 40, and doctors want that number to be above 60.
All of the participants continued to take their statins. About half were also given Niaspan and the rest, fake niacin pills, for a year.
As expected, HDL rose to an average of 47 in those on the drug and did not change in the comparison group. But blockages in a major artery got thicker in those who took fake pills, and held steady in those on Niaspan.
There also were fewer heart attacks, deaths, strokes and other problems in the Niaspan group - four versus 11 in those on fake pills.
Taylor said the results prove the double-barreled approach can work, and merits testing in bigger studies.
Dr. Raymond Gibbons, a Mayo Clinic cardiologist who had no role in the study, said it is important to explore new approaches because heart disease continues to worsen in many patients on statins.
Taking niacin or Niaspan at bedtime along with aspirin and a low-fat snack can minimize the flushing, Taylor said.
By Marilynn Marchione