Niacin: Ineffective, and Now with Fewer Side Effects!

I haven’t written about niacin for over a year, and like a misunderstanding of the Mayan calendar that won’t go away, niacin is in the news again this week. You can catch up on the old news by reading my previous posts (links below) but here’s the story in a nutshell. People with high levels of a cholesterol molecule called LDL tend to have more strokes and heart attacks than people with normal LDL levels. People with low levels of a cholesterol molecule called HDL tend to have more strokes a...
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CT Scans Not Very Helpful in Diagnosing Heart Attacks

Obstetrician 1: Get the EEG, the BP monitor, and the AVV. Obstetrician 2: And get the machine that goes 'ping!'. Obstetrician 1: And get the most expensive machine - in case the administrator comes. -- From Monty Python’s movie “The Meaning of Life”

Heart attacks remain the number one cause of death for men and women in the U.S. Heart attacks typically feel like squeezing or pressure in the center of the chest that lasts longer than a few minutes. More

Are You Obese?

Americans are getting heavier and have been doing so for decades. One in three adults in the US is obese. Overweight and obese people are more likely to develop diabetes, high blood pressure, heart disease, and other serious health problems. What can be done? Last month the ...
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Aspirin for Cancer Prevention not Ready for Prime Time

Let’s imagine that we had a hunch that lighting incense at midnight contributes to weight loss, and we wanted to test that hunch. How would we do that? We would recruit lots of overweight adults and (with their permission) randomly assign them into two groups. The first group would receive a wakeup call every night at midnight and would then light some incense. The second group would still receive a wakeup call (so that the sleep deprivation itself is not a difference between the groups) and w...
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Niacin Much Less Helpful in the Age of Statins

Niacin has been getting some bad press recently. A brief retrospective of Niacin’s rise to prominence will help us understand its recent fall from favor. Niacin is also known as vitamin B3 or nicotinic acid, a molecule that we need in tiny quantities in our food. As far back as the 1950s it was known that niacin in higher doses reduces blood levels of cholesterol. At that time our understanding of heart disease was in its infancy and there were few effective medications to treat or prevent card...
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A Revolution in Atrial Fibrillation Treatment

Atrial fibrillation is an irregular heart rhythm affecting about 3 million Americans. The most serious risk of atrial fibrillation is stroke, caused by a blood clot forming in the abnormally beating heart chambers and traveling to a blood vessel in the brain. For over 50 years the mainstay of atrial fibrillation treatment has been the anticoagulant warfarin (better known by the brand name Coumadin) which effectively decreases the risk of stroke by preventing blood clots. By the way, medicines t...
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FDA Warns of Risk of Highest Zocor Dose

What’s the difference between a medication’s intended effect and its side effects? Is there some physiologic difference between the beneficial effects of a medicine and the annoying or even toxic things that it does? Not really. All medications have lots of different effects on the body. The intended effect is simply the one that the patient (or doctor) hopes to achieve. The rest of the effects are by definition side effects. The difference lies purely in the intention of the patient and physici...
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Niacin Does Not Prevent Strokes or Heart Attacks

In the last decades we’ve made major strides in heart attack prevention through the use of blood pressure medications, smoking cessation, and statins – a family of cholesterol-lowering medications that have been proven to prevent heart attacks and strokes. Despite these advances, heart attacks remain the leading cause of death in the US. New medications to further decrease heart attack risk are being eagerly sought. Allow me a brief digression to explain three important fat molecules in your bl...
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Sitting Won’t Kill You, Except on Train Tracks

In the last couple of weeks the media has published stories making it sound like your Ikea chair is a death trap waiting to assist your suicide through the dangerous activity of sitting down. Stories with sensational titles like “Is Sitting a Lethal Activity?” (see link below) make you think that you’re better off walking outside for a smoke. Let’s spend a few minutes sifting the solid science from the wacky conjecture. You might as well sit down for this. The media interest in the idea that si...
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