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Saturday, April 17, 2010

Niacin for HDL-C

A recent reader of my DocSaleeby & Wellsphere blog was concerned about his abnormal ECG showing evidence of possible myocardial injury and his cholesterol. He wanted to know if he should start back on high dose Niacin.

My response:

Niacin may be one of the most potent agents out there for elevating HDL-C. However, once myocardial muscle (heart muscle) is damaged it goes through changes as all damaged tissue does, resulting in fibrosis and loss of elasticity, etc. and this cannot be reversed. Once heart muscle is damaged it cannot be repaired, hence the formation of scar tissue which hinders wall motion (as seen on ECHO) and in severe cases aneurysm formation. Prevention by plaque formation, stabilization of plaques, and reduction with the use of natural or synthetic statins (extract of fermented yeast of red rice or pravostatin for example) to reduce LDL-C is proven effective.

Raising HDL-C as a scavenger lipid is also proven and may be more beneficial to lowering LDL-C. If an ECG shows myocardial damage then it is wise to see a cardiologist to be studied further (Cath, ECHO, stress test) to determine the extent of you Coronary Artery Disease (CAD), as lipids are only one risk factor. You may have small coronaries, stable and/or unstable plaque formation (genetically predisposed), or other processes (hypercoagulable state) that may need specific attention and therapeutics. I recommend a daily dose of Aspirin (ASA 81mg) to all my patients over 45 if they are able to tolerate. For more on CADz, read my blog at

In good health,

JP Saleeby, MD

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