Treatment combining the cholesterol drug simvastatin with the B vitamin niacin lowers the risk of heart attack and other artery-disease complications by up to 90% in some patients. The study of 160 adults with clogged heart arteries and low HDL (good) cholesterol showed that 3 years of the combo treatment improved HDL levels, caused artery blockages to recede and significantly lowered heart complications compared with an inactive placebo.
Both lowering LDL, the "bad" cholesterol, and raising HDL help lower the risk of cardiac "events" such as heart attack. Brown, a researcher at the University of Washington in Seattle, and his colleagues reasoned that cutting LDL with a statin drug and raising HDL with niacin could potentially double the benefits for at-risk patients. And since low HDL may reflect an antioxidant deficiency, treatment with such vitamins could be expected to confer still more protection.
In the study, patients took either a combination of simvastatin (Zocor) and niacin alone, antioxidants alone, simvastatin-niacin plus antioxidants, or placebo. The antioxidant treatment included vitamins E, C, beta-carotene and selenium. Over 3 years, patients on simvastatin-niacin were 60% to 90% less likely than placebo patients to have a heart attack or stroke, need artery-clearing surgery or to die from causes related to their artery disease. These patients also showed a slight regression in their artery blockages, while on average all of the other groups showed worsening artery narrowing.
Patients on the combination plus antioxidants had more artery narrowing after 3 years and their HDL increases were not as strong compared with patients on simvastatin-niacin alone. Their risk of cardiac complications was lower, but not as low as that of patients on the combination alone. Treatment with antioxidants alone actually lowered an HDL component called HDL2 and did not cut patients' risk of heart attack and other complications.