An excellent read, sound advice, though studies are lacking

The one big reason why we use statins in daily clinical practice is not for the cholesterol lowering ability, but for the dramatic reductions shown in cardiovascular morbidity (disease occurence) and mortality (death). The Coronary Drug Project (1966-1975) was a randomized controlled trial that enrolled men between the ages of 30 and 65 who had already had one or more heartattacks, and randomized them to receive either niacin or placebo. Despite the impressive numbers that Dr. Parsons cites in his book, there were some significant drawbacks. The study did not enroll women or men of non-caucasian backgrounds, nor did it show impressive mortality benefit until about 6 or 7 years AFTER starting the drug. Statins have shown a role in both prevention of the first MI and prevention of recurrence, and separates from placebo at a much faster rate than Niacin did in its study.

To be fair to niacin, it does remarkable things for the HDL which is the good cholesterol. I have not had success with it in the past because I was probably dosing people wrong (too little, and all at once. His book suggests using higher doses and splitting the dose with meals), but I do have a fair share of patients who are quite leery of statins due to the press they have received with things such as memory loss, muscle aches, liver failure, etc. A recent study shows that niacin in addition to statins reduces risk further than a statin alone, but I have not seen head to head studies with niacin and statins. Although I do not do inpatient medicine, I know that people who are discharged with an MI from the hospital are put on statins. There is strong evidence to back up use of statins in patients with a prior MI, much more so than niacin. I believe that if you are relatively young, have a bad family history, and have other risk factors for heart disease (obesity, smoking) then niacin may be a good alternative. However, for people who are diabetic or who have already had an MI or a stroke, the rapid onset of protection with statins is much preferred. As always, talk with your doctor to see if niacin is right for you (ha ha, sounded like a commercial there).

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Finally, Help At Last!

This book may literally be a lifesaver for me!
I had a bad reaction to one of the statins. Then, tried every diet/food that i could try. Cholesterol went up.
Got the book and started Niacin. After one month of taking niacin, cholesterol went from 251 to 198!
Hasnt been that low in 5 years or more.
My doctor didnt know beans about niacin so Dr Parson's book was my last chance.
Thank you, Dr Parsons!

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The Truth About Cholesterol Control

This book contains a wealth of information about preventing heart attack and stroke, not limited to cholesterol control--although that is its main thrust. As in the first edition, it teaches that diet has so little to do with your cholesterol level that we might as well say it has nothing to do with it. The problem is that you inherited a body factory that produces too much bad (LDL) cholesterol, not enough good (HDL) cholesterol, or to much triglyceride. Total cholesterol is essentially irrelevant; you and your doctor need to know and manage all of those fractions.
To change the body factory requires medication. The best medication is niacin, which does everything right (lowers LDLC, triglycerides, and Lp(a)--"the heart attack cholesterol"--while raising HDLC. The widely advertised, expensive statin drugs do only one thing well--reduce LDLC. Statin drugs had, until 2001 (no later figures available) caused 112 deaths in the US and resulted in withdrawal of one such drug (Baycol) from the market. Statins do this by causing rhabdomyolysis ("dissolving of muscles"), with circulating myoglobin then blocking the kidneys, causing kidney failure. The muscle pains that often accompany statin use are warning signs to stop those drugs. Read the fine print ot listen closely to the fast talk at the end of commercials, then decide whether the statin manufacturers are trying to sweep these hazards udner the rug.
Some experts think statins may, in time, prove to cause cancer, based on the fact that they all cause cancer in animals.
Niacin has a safety record dating to the 1950's, when the author pioneered its use at the Mayo Clinic. A landmark study, sponsored by NIH (not by drug companies) showed (in men who had already had one or more heart attacks) that niacin reduced both heart attacks and strokes by 25%, while also reducing cardiovascular surgery, hospitalization, and deaths--as compared to other drugs or to placebo.
Why, then, haven't we heard more of niacin? Because it's not patentable; thus no one company benefits from its exclusive sale. Reliable, inexpensive niacin products are available. This is not a fad supplement; niacin has been approved by FDA for cholesterol control since the early 1960's.
Although available without prescription, "niacin is not a do-it-yourself drug," the autrhor points out repeatedly. It require knowledgeable medical supervision to monitor cholesterol results and be sure there are no untoward side effects. The nuisance effect of skin flushing at the onset of treatment is easily avoided by using time-release products and a daily aspirin for the first week or two. The book dispels rumors and myths that niacin is hard to take or that time-release products should be avoided.
Worried about prescription drug costs and statin hazards? Niacin costs $10-14 a month for usual doses (less than the co-pay of most prescription drug plans), while statin prices vary from $42 to $142 a month, depending on drug and dosage.
This book emphasizes what Laura Bush recently learned: that in women, heart attacks cause more deaths each year than all cancers combined. The book takes the position that heart attacks and strokes are largely preventable. A second copy for your doctor is a good idea. And since obesity has been upgraded to a major risk factor for heart attack (as well as diabetes and worn-out weight-bearing joints), you might also do well to consult the author's newest book, Tough Talk About Fat! How to Reach and Maintain Your Ideal Weight. (It doesn't scold a person for being overweight; it tells him to GET TOUGH with that excess weight and get rid of it--all of it!)

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