Some things in medicine seem like common sense, but they are not.
Since heart disease and osteoporosis increase after menopause, when estrogen levels drop, it was thought that supplementing estrogen would help. Then the WISE study demonstrated that there may actually be harm in taking estrogen.
Diets high in fruits and vegetables, which in turn are high in vitamins, nutrients, and phytochemicals, lead to decreased risk of heart disease. So, it would make sense that vitamin supplements would help, right? Many studies and meta-analyses have looked at whether supplementing B vitamins, vitamin E, folate, or coenzyme Q10 would reduce the risk of heart disease. Not a single study has shown that vitamin or mineral supplementation reduces heart disease. In fact, vitamin E supplementation may increase the risk of stroke.
But niacin was thought to be different. Niacin raises HDL ("good cholesterol") levels and lowers triglycerides and LDL levels. Several small studies showed that niacin alone might reduce risk of cardiovascular events. Therefore, it was thought that if some is good, then more is better.
The AIM-HIGH trial of more than 12,000 patients already on statins with controlled LDL cholesterol sought to determine whether addition of long-acting niacin would further reduce cardiovascular events. However, the trial was recently stopped early because patients showed no decrease in cardiovascular events, but did experience an increase in risk for stroke. This increase in stroke was somewhat surprising, and there is no obvious explanation for the small but significant increased risk of stroke.
Another drug, torcetrapib, a CETP-inhibitor, which raises HDL, was studied a few years ago as a hope for patients with heart disease. However, studies showed increased all-cause mortality amongst patients on a combination of a statin and torcetrapib.
Dr. Neal Barnard of PCRM, the Physicians Committee for Responsible Medicine, has an interesting take on the subject. Artificially raising the HDL with medicine like niacin may not be what helps people live healthier and longer. The key may be healthy diet and exercise, which in turn raise HDL levels.
Better living doesn't necessarily come from better pharmacology. Healthy diet and lifestyle are still the cornerstone of reducing heart disease risk.