Battling Heart Disease Risk In Diabetic Patients

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Controlling Risk Factors

The general approach to preventing cardiovascular disease includes strategies to reduce the overall CHD risk by lifestyle modification and managing modifiable risk factors such as diabetes, hypertension and smoking. Even if patients are at risk for CHD, explain to them that they can eliminate many of the major risk factors by making simple changes in diet and lifestyle. These changes include:

• controlling the cholesterol level;
• controlling high blood pressure (hypertension);
• quitting smoking;
• losing weight if necessary;
• getting active; and
• managing stress.

Regardless of the intervention used (diet, drugs, surgery), reduction of plasma cholesterol has consistently produced a reduction in cardiovascular risk.

18
Author(s): 
By Bhavesh J. Shah, DPM

Can Niacin Make An Impact?
Niacin (nicotinic acid) is one of the oldest drugs to treat high cholesterol. Niacin displays potent ability to lower LDL cholesterol and triglyceride levels and elevate HDL cholesterol levels. It is one of eight water-soluble B vitamins which help convert carbohydrates into glucose and are also essential in the breakdown of fats and protein.
At high doses, niacin has been shown to prevent and/or improve symptoms of high cholesterol, atherosclerosis, diabetes, osteoarthritis, cataracts and burns. In fact, a study conducted and published in JAMA found that niacin increased HDL levels by 29 percent, decreased triglycerides by 23 percent and LDL by 8 percent.3 Researchers also noted mild increases in glucose levels, although levels of HbA1C were unchanged from baseline.
The researchers also concluded that lipid-modifying dosages of niacin can be safely used in patients with diabetes and that niacin therapy may be considered as an alternative to statin drugs in treating patients with diabetes who cannot tolerate the statin agents.3
Another study comparing lovastatin with niacin concluded that niacin increased HDL by 16.3 percent compared to 1.5 percent for lovastatin and decreased triglycerides by 18.4 percent compared to 0.8 percent by lovastatin.6
Niacin is available in several different forms: niacinamide, nicotinic acid and inositol hexaniacinate. The form niacin is best tolerated with the least symptoms is inositol hexaniacinate. Niacin is available as a tablet or capsule in both regular and timed-release forms. The timed-release tablets may have fewer side effects than the regular niacin but are more likely to cause liver damage.
Niacin is contraindicated in patients with a history of stomach ulcers or liver disease and periodic liver function tests are recommended.
High doses of niacin can cause side effects such as “niacin flush,” which is burning, tingling sensation in the face, chest and red or “flushed” skin.5 However, researchers note that taking an aspirin 30 minutes prior to niacin may help reduce the symptoms.

Final Notes
Like most medications, niacin is not without its share of contraindications. However, its effects in lowering risk factors for heart disease far outweigh its potential side effects. Indeed, adding a vitamin to conventional lipid-lowering medications may prove, if used effectively, beneficial in lowering the risk of heart disease with diabetes.

Dr. Shah has a private practice in San Antonio, TX.

Dr. Steinberg (pictured) is an Assistant Professor in the Department of Orthopaedics / Podiatry Service at the University of Texas Health Science Center.




References:

References

1. Mokdad AH et. al.: Diabetes trends in the U.S.: 1990-1998. Diabetes Care 23(9), 2000.
2. Heart disease, http://www.diabetes/heartdisease.com.
3. Elam, MB et. al.: Effect of Niacin on Lipid and Lipoprotein levels and Glycemic Control in patients with Diabetes and Peripheral Arterial Disease: JAMA 2000, 284:1263-70.
4. Lavie, CJ et. al.: Marked Benefit with Sustained-Release Niacin therapy in patients with Isolated levels of High-Density Lipoprotein Cholesterol and CAD: AJ Cardiology: 1992, 69:1083-1085.
5. Cullen, P et. al.: Evidence that Triglyceride are an Independent Coronary Heart Disease Risk Factor: AJ Cardiology: 2000, 86:943-949.
6. O’Connor, PJ: Relative Effectiveness of Niacin and Lovastatin for treatment of dyslipidemias in A Health Maintenance Organization: J. Family Practice, 44(5):462-7, 1997.

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