Dr. Jarvik, is niacin as bad as it sounds?

A popular health newsletter, Everyday Health, carried this headline:

A Cholesterol-Busting Vitamin?

Did you know that niacin, one of the B vitamins, is also a potent cholesterol fighter?
Find out how niacin can help reduce choleseterol.

At doses way above the Recommended Dietary Allowance — say 1,000–2,500 mg a day (1–2.5 grams) — crystalline nicotinic acid acts as a drug instead of a vitamin. It can reduce total cholesterol levels by up to 25%, lowering LDL and raising HDL levels, and can rapidly lower the blood level of triglycerides. It does so by reducing the liver’s production of VLDL, which is ordinarily converted into LDL.

I'd agree with that, except that it is rare to require doses higher than 1000-1500 mg per day unless you are treating lipoprotein(a) and using niacin as a tool for dramatic drops in LDL. But for just raising HDL, shifting HDL into the healthy large class, reducing small LDL, and for reduction of heart attack risk, 1000-1500 mg is usually sufficient; taking more yields little or no further effect.

But after that positive comment comes this:

Niacin is safe — except in people with chronic liver disease or certain other conditions, including diabetes and peptic ulcer. . . However, it has numerous side effects. It can cause rashes and aggravate gout, diabetes, or peptic ulcers. Early in therapy, it can cause facial flushing for several minutes soon after a dose, although this response often stops after about two weeks of therapy and can be reduced by taking aspirin or ibuprofen half an hour before taking the niacin. A sustained-release preparation of niacin (Niaspan) appears to have fewer side effects, but may cause more liver function abnormalities, especially when combined with a statin.

Strange. After a headline clearly designed to pull readers in, clearly stating niacin's benefits, the article then proceeds to scare the pants off you with side-effects.

But look to the side and above the text: Ah . . . two prominent advertisements for Lipitor, complete with Dr. Robert Jarvik's photo. "I've studied the human heart for a lifetime. I trust Lipitor to keep my heart healthy."

Niacin bad. Lipitor good. Even celebrity doc says so. Sounds like bait and switch to me. "You could try niacin--if you dare. But you could also try Lipitor."

Who is Dr. Jarvik, anyway, that he serves as spokesman (or at least figurehead) for this $13 billion dollar a year drug? Of course, he is the 1982 inventor of the Jarvik artificial heart, surely an admirable accomplishment. But does that qualify him to speak about heart disease prevention and cholesterol drugs?

Jarvik has never--never--actually prescribed Lipitor, since he never completed any formal medical training beyond obtaining his Medical Doctor degree, nor has he ever had a license to practice medicine. He does, however, continue in his effort to provide artificial heart devices, principally for implantation as a "bridge" to transplantation, i.e., to sustain a patient temporarily who is dying of end-stage heart failure.

So where does his expertise in heart disease prevention come from? It's beyond me. Perhaps it was the thousands of dollars likely paid to him. That will make an "expert" out of just about anybody.

Robert Bazell, science reporter, for CNBC, made this report on the Jarvik-Lipitor connection in his March, 2007 report, Is this celebrity doctor's TV ad right for you?

Mr. Bazell writes:

On May 16, 1988, an editorial in the New York Times dubbed the artificial heart experiments, “The Dracula of Medical Technology.”

“The crude machines,” it continued, “with their noisy pumps, simply wore out the human body and spirit.”

Since then, in a series of start-up companies, Jarvik has continued his quest to make an artificial heart — as have several other firms. One competitor recently won FDA approval to sell its device for implantation in extreme emergencies.

Perhaps Jarvik’s chances of success with another artificial heart account for his willingness to serve as pitchman for Pfizer. I inquired, without success, to find the going rate for a semi- celebrity like Jarvik to appear in such ads. Thomaselli of Advertising Age said whatever it is, it is “infinitesimal” compared to Pfizer’s expenditures of $11 billion a year on advertising, much of it for Lipitor.

Why spend so much marketing Lipitor?

Because Lipitor is only one of six drugs in the class called statins that lower cholesterol. Many cardiologists say that for the vast majority of people any one of these drugs works just as well as the other. Two of them, Mevacor and Zocor, have already lost their patent protection so they cost pennies a day compared to $3 or more a day for Lipitor.

In 2010, when Lipitor loses its patent protection, it, too, will cost pennies a day, and Pfizer will no longer need Dr. Robert Jarvik.

So, is niacin so bad after all? Or is this Everyday Health report just another clever piece of advertising for Pfizer?

Comments (5) -

  • jpatti

    10/20/2007 8:43:00 PM |

    When you're diabetic, so many drug choices wind up being about that.  For instance, I was switched to carvedilol (at my request) as it's the only beta-blocker that doesn't raise bg and actually seems to improve insulin resistance.

    I think it is true that niacin at doses therapeutic enough to effect lipid panels is a drug, not a vitamin.  This isn't to say it's bad, but that it has to be evaluated as a drug.  And the best I've been able to find wrt to niacin use in diabetics is that 1-1.5 g of extended release only raises bg slightly.  

    However, the increased A1c, even if slight, bothers me.  Even in non-diabetics, A1c is highly correlated with heart disease; very slight changes seem to be significant.  So it is difficult to decide if the increased glycolyation of blood proteins outweighs the benefits of niacin.  

    Have you seen improvements in heart scan scores in diabetics treated with niacin?

  • Dr. Davis

    10/21/2007 12:59:00 AM |

    Yes, dramatic reductions in heart scan scores, in fact.

    I think that the glucose/niacin interaction needs to be evaluated individually, since it can vary enormously from one person to another, though usually small to minimal.

  • over&out

    10/21/2007 11:16:00 PM |

    1500 niacin has lowered my LP(a)from 90 to 28. Also alternate between 10mg and 5mg daily of Lipitor to keep LDL & Trigs about 35. Cardiologist says "less trains = less passengers". HDL at 60-70. Found Immediate release worked best for me. Reading good things about that combo on PUBMED.com. Doing it for 5 yrs now. Thanx for your helpful posts, a must read for me every day. Over&Out

  • Ruth

    11/18/2007 9:11:00 PM |

    I just want to thank you for you site.  I was actually doing some research for a criminal justice class and found more info than I was looking for, I will be back to your site, I have parents in their 80's and my mom is diabetic, I found info on here that will help her, my stepdad and my mother in law.  Have a wonderful day!

  • buy jeans

    11/4/2010 6:35:01 PM |

    Niacin bad. Lipitor good. Even celebrity doc says so. Sounds like bait and switch to me. "You could try niacin--if you dare. But you could also try Lipitor."