HEALTH MATTERS: Addition of niacin to a statin not recommended

Q. I take niacin to help control my cholesterol. It causes a lot of flushing of my skin, and I don’t know how much it helps. Should I stop it?

A. First of all, unless it is an emergency situation, always visit with your health care provider first about any changes or discontinuation of your medications. Second, the redness and tingling of the skin that you are experiencing often can be controlled with aspirin.

Again, check with your provider. But you also raise a most important question: How much does niacin really help? Although niacin has been around as a treatment for high cholesterol for almost 60 years, we are only now learning about its true benefit. And that benefit seems to be quite small, at least when niacin is added to the usual class of medicines that are used to treat high cholesterol such as the so-called statins, including simvastatin, pravastatin and atorvastatin.

We had thought that adding niacin to a statin would increase the good cholesterol in the blood and further reduce both the bad cholesterol and another bad lipid called triglycerides. A recent clinical trial found that while niacin had some modest beneficial effects on the cholesterol numbers, patient outcomes were unchanged by the addition of niacin to a statin.

Based on the results of this well-conducted study, I now do not recommend the addition of niacin to a statin, but ordinarily would reserve the use of niacin to those patients who cannot tolerate a statin. I would suggest that you check with your provider and ask about discontinuing the niacin. Maybe you should bring a copy of this column with you to your next visit.

Q. My husband just had a pacemaker inserted, but I don’t really understand what a pacemaker does. Please explain.

A. Pacemakers are small self-contained electronic devices that are surgically implanted under the skin in the upper chest and are connected to a wire or wires that are threaded down veins to the heart. The pacemaker wire stimulates one or more parts of the heart with a tiny electric current designed to cause that part of the heart to beat.

There are three major uses for pacemakers and pacemaker-like devices.

The most common role for a pacemaker is to correct an abnormally slow heart rate, which is often caused by problems with the heart’s intrinsic pacemaker activity that can fail (particularly as the heart ages). Two leads are often placed in the heart, one to stimulate the upper chambers of the heart or the atria and the other to stimulate the bottom chambers of the ventricles.

The second type of pacemaker is designed to help the heart contract in a more organized way. This pacemaker uses two leads to stimulate the ventricles to contract in such a way that they beat more forcefully. This type of pacemaker is called a biventricular pacemaker. The last type of pacemaker-like device is designed to shock potentially lethal rhythm abnormalities back to regular rhythm. Called an ICD or internal cardioverter defibrillator, this device is most commonly used in people whose hearts are enlarged, flabby, and weak.

Wynne is vice president for health affairs at UND, dean of the School of Medicine and Health Sciences, and a professor of medicine. He is a cardiologist by training.

Submit a question to Health Matters at healthmatters@med.und.edu or Health Matters, 501 North Columbia Road, Stop 9037, Grand Forks, ND 58202-9037. Remember, no personal details, please.

The content of this column is for informational purposes only and does not substitute for professional medical advice or care. The information provided herein should not be used for diagnosing or treating a health problem or disease. If you have or suspect you may have a health problem, you should consult your health care provider. Never disregard professional medical advice or delay in seeking it because of something you have read in this column.

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