Re: Try to use herbs to lower your cholesterol
From: GMCarter (fiar_at_verizon.net)
Date: 12/17/04
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Date: Fri, 17 Dec 2004 09:27:18 GMT
On 17 Dec 2004 01:30:37 GMT, jamie@spam-me-silly.net (jamie) wrote:
snip
>Niacin in reasonable moderation is not a help for high cholesterol.
>When it's used for treating high cholesterol, it's very high doses,
>up in the disrupt-liver-function range, and can cause liver damage
>if using the wrong form and not monitored by a doctor.
Niacinamide is a form that people use to avoid flushing/itching
reactions niacin can cause. However, it has NO benefit for
dyslipidemia. Niacin doses ranging from 1 gram to 8 grams per day have
been used in clinical studies. The NEJM had a good article on slowly
ramping up the dose, and that usually offsets the flushing response
but not always. Sustained release forms may be problematic for
hepatotoxicity.
Other agents of interest for lipid dyscrasia management include
policosanols (sugar cane wax derived), pantethine, possibly carnitine,
fish oils and yes, a variety of other agents. Addressing diet and
exercise is really key, tho.
George M. Carter
**
Guyton JR. Extended-release niacin for modifying the lipoprotein
profile. Expert Opin Pharmacother. 2004 Jun;5(6):1385-98.
Duke University Medical Center, Department of Medicine, Durham, North
Carolina, USA. john.guyton@duke.edu
Niacin (nicotinic acid) favourably modifies all aspects of the
lipoprotein profile; it raises high-density lipoprotein cholesterol
(HDL-C) levels, lowers triglyceride, low-density lipoprotein
cholesterol (LDL-C) and lipoprotein(a) levels and reduces atherogenic
small, dense LDL particles. One large monotherapy trial and multiple
trials of niacin in combination with other lipid-modifying drugs show
remarkable consistency in the ability of niacin to improve
angiographic and clinical outcomes. In practice, however, the use of
regular, immediate-release niacin (niacin IR) has been limited by the
side effect of flushing. Sustained-release (SR) formulations,
developed in order to reduce flushing, were found to cause serious
hepatotoxicity at varying frequencies. Extended-release niacin (niacin
ER; Niaspan), Kos Pharmaceuticals, Inc.) is a prescription formulation
of niacin, administered once-daily at bedtime. Niacin ER is as
effective in modifying lipoprotein levels as an equal daily dose of
niacin IR and it causes less flushing. In addition, niacin ER
administered once-daily is not associated with the increased
hepatotoxicity reported with SR formulations. Niacin ER has been
studied extensively in combination therapy with statins, including
lovastatin in a recently introduced combination tablet. Myopathy has
not been a substantial problem in statin/niacin ER combination
therapy. Finally, a study of niacin ER given to diabetic patients
showed only mild trends towards increased glycosylated haemoglobin
concentrations and a need for additional antidiabetic medication.
Thus, niacin ER represents an effective and safe option in the
management of low levels of HDL-C and other lipoprotein abnormalities
in a variety of settings.
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