Surprising results suggest that raising patients’ good cholesterol did not seem to matter against heart disease.
Low HDL is one of the hallmarks of metabolic syndrome. If you take measures to lessen or eliminate the syndrome's root cause, which is overloading an individual's personal carbohydrate handling capacity, either via inappropriate diet or neglect of defective postabsorptive glucose regulation, metabolic syndrome's progress may be reversed. This can spare the body the ravages the syndrome's elevated insulin and glucose levels can cause. Since reversing the syndrome's course will cause a depressed HDL to rise back to normal levels, rising HDL levels end up positively correlated with improving health outcomes.
But driving HDL higher with a drug is like trying to decrease the accident proneness of speeding cars by forcing the speedometer needle to indicate a lower reading.
If you want to avoid heart disease, cut way back on the things that really cause it: refined sugars, fruit juice, and starchy foods like potatoes, bread, cereal, pasta and rice. Get your carbohydrates mostly from vegetables with lower amounts of starch and sugar. Don't vastly overconsume protein. And do get plenty of real foods high in natural saturated fats and cholesterol: fatty meats, eggs, full-fat dairy products, and tropical oils.
You'll end up with high HDL and low triglycerides and VLDL. When you have this lipid profile, an LDL number that's anything short of astronomical is meaningless as a heart disease risk factor because your LDL will be mostly innocuous "large buoyant" particles.
Anybody who tries manipulating LDL down or HDL up with drugs needs his or her head examined - literally. Especially statins are notorious for causing serious neurological side effects.
The entire cholesterol 'enterprise' has been a tool for one thing only: generating profits through the marketing of cholesterol-lowering drugs. Ravnskov has clearly detailed the questionable methodology used to hype the 'condition' and get as many people as possible on statins.
This is a good example of the importance of much more research into medical effectiveness. As a statistical consultant who has worked on studies at UCSF and other leading centers, I have learned that about a third of medical expenditures are spent on totally useless steps, and another third are spent on things that actually harm patients.
To see why this happens, go to YouTube and watch aoe Health6. Then support the section of the new health care law which funds investigations into medical effectiveness. These are life panels, not death panels.
bill at realamerica.webs.com
While the trial may be bad news for drug companies, it's good for patients. More information is always a good thing; that's how science operates. In the end, it seems this is further confirmation that the simplest advice - exercise, eat well, relax - is often better than the most highly promoted and faddish drugs.
Rapid City , SD
The thinig with medicine is that it keeps changing all the time. First eggs were bad, then salt was bad,then coffee was bad,now dark chocolate is good and we all need some fat and some salt and eggs in moderation is good. If we all just ate healthy in moderation, perhaps that is all that would be needed to have a healthier circulation system and not worry about every new study some researcher has done only to have it changed some years later. This could eliminate the stress of trying to figure out what is good and bad over time.
I'd be willing to bet that the reason Niacin didn't help reduce heart attacks by raising HDL is that exercise also raises HDL. Here's the logic. People with high HDL magically seem to have fewer heart attacks. Science is overlooking the fact that the raised HDL is probably the result of exercise - and the exercise is what is causing fewer heart attacks. Simply raising someone's HDL artificially through the use of drugs is not going to provide the same benefits that exercise does.
This study again reinforces the reason it's called "The practice of medicine" and not the "science of Medicine" it also demonstrates why medical treatment and drugs are expensive, most of what works was found the hard and expensive way by trial and error. We are just coming to realize that a patients genes influence the course of diseases and the response to treatment more than was ever thought. "One size fits all" medical treatments and their imagined savings are as much an illusion as the water on the highway on a sunny day. More and more effective medical treatment will need to be based on knowing the individual and their genes. This will save lives, produce better outcomes, and cost more money. There is no simple solution to this moral dilemma because it's not a simple problem and the other half of the problem that few governments will face is that better outcomes mean yet more people on a planet that is very close to it's capacity now. Yet to not do the research to improve people's lives is equally unthinkable for most of us. Especially if we or our loved ones are the patient.
I'm a patient, with a background in statistics, who has tried to follow medical research in areas which most impinge on my health, for many years.In total, I have come to respect it. But figuring out when to be a believer and when to be a sceptic is the very devil. I do know that statistical quality in the design and interpretation of studies is highly variable .This is an important criterion in deciding when caution is advisable. Another reason for patient caution is that media coverage of research is often misleading.
So niacin and Niaspan are useless in stopping the progression of cardiovascular disease, let alone reducing plaque that's already built up, as Niaspan's ads claim "may" be possible. I'm sure the many people who have been paying for and taking that drug are delighted with this news.
This is an example of what happens when prescription of pharmaceuticals is part of for profit medicine. Advertising promoting Niaspan cost a pretty penny and increased the price of an expensive drug that has turned out to be ineffective. How many other drugs are on the market, are being vigorously promoted, and are also basically worthless to patients?
These drugs certainly are NOT worthless to pharmaceutical companies who have supposedly proven their effectiveness to get FDA approval or to the media that profits from advertising them. Direct to consumer drug advertising is not in the best interest of our health care system but the profits are huge for both pharmaceutical companies and for the media, so strictly limiting and regulating marketing of pharmaceuticals and medical devices again is going to be impossible with two very powerful interests lobbying Congress to keep regulation minimal so their profits keep rolling in.
The FDA has got to require that, before approval, new drugs must be tested, not against placebos, but against the standard medication already in use, to show that new medication is actually an improvement over the previous treatment. Every new drug that appears on the market has side effects, some of which can be fatal or cause permanent damage or make people very ill. Shouldn't new medications, which carry higher risks of as yet undiscovered serious side effects, at least have to prove that they are worth that risk versus drugs already on the market?
However, the FDA is ridiculously understaffed as well as compromised by its too cozy relationships with the enormous medical industrial complex it's supposed to be regulating. I no longer trust FDA approval to mean that a drug is actually effective or reasonably safe for me to take. As far as I'm concerned, we have returned to the days of "patent medicines" sold by hucksters from their wagons as they drove from town to town. The alcohol, cocaine, and opiates in those medications were probably safer than many of the drugs on the market today. Now more people are dying every year from abusing and overdosing on prescription drugs than are killed by street drugs.
Our government sat on its hands while for profit HMO's drove nonprofit hospitals and clinics out of business. Our government decided to allow direct to consumer prescription drug advertising; who do you think was lobbying for that? Our government has let the for profit health insurance industry prey on Americans for years as companies have refused to cover people with pre-existing conditions, dropped patients who develop expensive medical problems, and made life and death decisions about what they will and won't cover.
Everyone whines about the increased cost of health care in this country. Costs have increased because our government has enabled these costs to be driven ever upwards by for profit HMO's, pharmaceutical and medical device companies, and health insurance companies. The free market created this monstrosity we call our health care system. The sky high cost of health care in this country is the result of our culture's erroneous belief that everything works better if it's in the marketplace. With health care, ESPECIALLY with health care, this simply is not true. Niaspan is one more piece of evidence in the enormous pile of evidence that our system is not working.
Only one of these comments begins to address the reason why we keep getting "surprised" by the results of these simplistic, randomized controlled trials. They are not good science. They really are simplistic comparisions of outcomes based on a set of often poorly defined assumptions. Almost all of the clinical research being done is conducted to meet the marketing approval or labeling standards of the FDA. The FDA's standards and science are hopelessly obsolete, based on concepts developed in the late 1950s and early 1960s. They not only admit this, they actually strictly enforce these 50 year old approaches, claiming that the law requires them to do that. The randomized clinical trial and the simple, extremely narrow and often misleading results that flow from them (in a tiny, enormously expensive, galcially-slow trickle) is the problem. We are asking the wrong questions in these trials, and as a result, we don't get useful or even reliable answers. This trial actually tells us only one thing - there wasn't a statistically-significant difference in heart attack frequency between those getting niaspan and those not getting it. We learned virtually nothing about why that outcome occurred, or whether there were individuals in either group who receive benefit or harm due to patient specific factors, like for example, genetics). We can design and conduct much more scientific studies that would ask and answer more of these questions, but FDA refuses to consider anything but a very, rigid and narrow population-based, statistics driven approach for virtually all of its decision making. Population-based statistics is a very poor replacement for real medical science as we now understand it, but at the FDA statistics is the only game in town. Until that changes, personalized medicine (the right drug(s) to the right patient at the right time) is going to languish. Get ready for the confusion and hand-wringing this almost useless statistical and medically uninterpretable result precipitates, and expect it to be many decades before we actually understand the relationship between cholesterol, triglycerides, genetics, lifestyle, etc. and heart disease. The FDA is adamantly insisting the we continue to use these simplistic comparisons where we don't ask the right questions; consequently, the right answers will remain unknowable. Of course, we could just start doing some real science and know the answers much, much sooner, but for our backwards, scientifically stagnant FDA.
Notably, the study focused on whether a prescription niacin medication when added to statins further reduces risk of heart disease, but not whether ordinary niacin alone is as effective as statins in reducing risk. Why? Presumably, the drug company that sponsored it, which patented the statin but can't patent ordinary niacin, doesn't want to know. Yes, the company now can't easily market both drugs for a single patient, but it can still sell both of its products. How scary would it be if its study showed that ordinary, over the counter niacin, which costs pennies per tablet, were as effective as prescription statins, and/or prescription niacin medication.
May 27th, 2011
Actually, since cholesterol is literally in every cell of the body (including the brain where besides the liver, it it also manufactured, for very good reason!) and whereas we would die if were to go too low, I would say the the term "good cholesterol" is not an oxymoron but rather an indicator of a completely misunderstood and overly simplistic but commonly held view. Mel Presley says it pretty clearly in his post above: Cholesterol is not the enemy-in point of fact it is neither good nor bad. However, certain ratios (HDL to total cholesterol for instance)can be indicators of metabolic imbalance which can lead to serious consequences. If one reads up on it, it becomes clear that what really matters is how one can implement lifestyle changes in order to avoid metabolic syndrome by cutting out excess carbs (the quickly metabolized ones such as refined flours, and potatoes especially,) sugars (fructose and sodas etc,) and eating a diet rich in vegetables and high quality proteins. Also, some saturated fats are needed as they are heart protective (the right kind) and help with the absorption of EFAs, another important part of the puzzle. Cutting down of the "bad" carbs and sugars has the added advantage of lowering blood pressure and regulating blood sugar which ensures one will be less likely to develop diabetes. It's all correctable with diet and exercise, unless you are one of the unfortunate individuals who truly has a genetic metabolic disorder.
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Reversing High Cholesterol
Surprising results suggest that raising patients’ good cholesterol did not seem to matter against heart disease.