SEATTLE - Combining a cholesterol-lowering
drug with the vitamin niacin can reduce some patients' risk of heart
attack, stroke and hospitalization for chest pain by about 70 percent,
University of Washington researchers have found in a new study of
patients with cardiovascular disease.
''The disease is stopped in its tracks, and there is actually a
reversal of disease,'' said Dr. B. Greg Brown, UW professor of
medicine and director of the research, which is reported in today's
edition of The New England Journal of Medicine.
Patients in the study took simvastatin, one of the statin class of
anti-cholesterol drugs, and niacin, a vitamin of the B-complex group
long touted as being good for the heart.
More than half of the 12 million Americans with coronary-artery
disease could benefit from the treatment, Brown estimated. It both
raises ''good cholesterol,'' which helps prevent heart disease by
removing fats from the blood, and lowers ''bad cholesterol,'' which
causes a buildup of artery-blocking plaque.
Sponsored by the National Heart, Lung and Blood Institute, the
research also found that a combination of anti-oxidants - vitamins C
and E, beta carotene and selenium - did not help reduce heart
problems, as other research has suggested it might. Instead, the
vitamins blunted the beneficial effect of simvastatin and niacin.
''I used to tell my patients to take the vitamins ... but I don't
now,'' Brown said.
He is a pioneer in the use of statin drugs to lower cholesterol,
directing the first study, involving lovastatin, that decreased
arterial blockage and heart attacks. Statins are now commonly given to
people with heart disease when diet and exercise don't sufficiently
lower cholesterol. A statin generally reduces cardiovascular risk by
about 35 percent over five years of treatment.
The new research showed that adding niacin to simvastatin, sold
under the brand name Zocor, is a dramatic improvement. The combination
both stops the narrowing of coronary arteries - even slightly reducing
the blockage - and reduces the risk of fatal and nonfatal heart
attacks, strokes and procedures for chest pain by a range of 60 to 90
''It's like getting hearing improvement from having a hearing aid
in one ear and then putting them in both ears and getting even more
improvement,'' said Brown.
Scientists from the UW, the University of British Columbia in
Vancouver and the Oklahoma Medical Research Foundation in Oklahoma
City participated in the research. They studied 160 patients with low
levels of HDL, the good cholesterol, and with normal levels of LDL,
the bad cholesterol. This is typical of 40 percent of all patients
with heart disease.
The patients were separated into four groups and were studied for
three years: One group received simvastatin and niacin; another
received only anti-oxidants; another received all the treatments;
another received placebos.
In the simvastatin-and-niacin group, the average HDL level
increased 26 percent, and the average LDL level dropped 43 percent.
Anti-oxidants reduced these effects, though researchers were unsure
Simvastatin and niacin also caused an average 0.7 percent reduction
in arterial blockages, but the blockages increased slightly in the
other groups, including a 1.9 percent increase in the anti-oxidant
Brown said similar results probably would occur with other statin
drugs, though simvastatin was the only cholesterol-lowering drug used
in the study. The combination treatment also probably would benefit
patients with high triglycerides and borderline-high LDL, Brown said,
''though that has not been proved.''
One statin drug, Baycol, or cerivastatin, was recalled last spring
after 31 deaths stemming from muscle destruction were reported among
users. At the time, some health experts also criticized other statin
drugs for causing muscle pain in some patients.
Brown said the combination treatment used a low dose of simvastatin
and that none of the patients experienced muscle pain.
A much larger study of the combination treatment, involving many
more patients, is warranted, Brown said. It could confirm the UW
research and better measure the treatment benefits. But he said many
physicians and patients would contend that the UW study is sufficient
evidence to begin using simvastatin and niacin.