Is niacin bad for you? Too much of this common B vitamin could trigger heart problems

April 25, 2024

A common B vitamin might actually be harmful for your health. Researchers at Cleveland Clinic have made a significant breakthrough in understanding how high levels of niacin (vitamin B3) could lead to cardiovascular diseases, reports Study Finds.

The study identifies a new pathway through which excessive dietary niacin contributes to heart disease, challenging previous beliefs about the vitamin’s health benefits.

Niacin is prevalent in the Western diet and has been widely fortified in foods such as flour, cereals, and oats for decades to prevent nutritional deficiencies. However, this new research indicates that overconsumption of niacin can lead to elevated levels of a metabolite known as 4PY, which is now linked to an increased risk of heart attack, stroke, and other cardiovascular events.

Foods that are rich in niacin include red meat, poultry, fish, brown rice, fortified cereals and breads, nuts and seeds, beans and peas, and bananas.

The study’s findings are based on a combination of large-scale clinical studies and preclinical experiments. Researchers discovered that high circulating levels of 4PY are strongly associated with the development of cardiovascular diseases, primarily through its role in triggering vascular inflammation. This inflammation can damage blood vessels, leading to atherosclerosis, a condition characterized by stiff, hardened arteries.

“What’s exciting about these results is that this pathway appears to be a previously unrecognized yet significant contributor to the development of cardiovascular disease,” says study lead author Dr. Stanley Hazen, Chair of Cardiovascular and Metabolic Sciences at Cleveland Clinic’s Lerner Research Institute and Co-Section Head of Preventive Cardiology in the Heart, Vascular & Thoracic Institute, in a media release. “What’s more, we can measure it, meaning there is potential for diagnostic testing. These insights set the stage for developing new approaches to counteract the effects of this pathway.”

Researchers also delved into genetic links between 4PY and vascular inflammation—offering a foundation for future studies aimed at reducing or preventing this inflammation. The work opens the door to developing new approaches to counteract the effects of the 4PY pathway, potentially revolutionizing how we view niacin’s role in our diet and its implications for heart health.

Despite niacin’s long-standing recommendation for lowering cholesterol, the study suggests a reevaluation of niacin fortification in food and the use of niacin supplements.

“The main takeaway is not that we should cut out our entire intake of niacin—that’s not a realistic approach,” notes Dr. Hazen. “Given these findings, a discussion over whether a continued mandate of flour and cereal fortification with niacin in the United States could be warranted.”

The study’s broader implications include a potential rethinking of dietary guidelines and fortification practices, especially in the United States, where niacin fortification has been mandated for over fifty years.

The study has been published in the journal, Nature Medicine.

Research contact: @StudyFinds

Sepember 12, 2024

The Centers for Disease Control and Prevention (CDC) reported in back in September 2016 that one in four Medicare participants age 65 or older—that’s 5 million people—do not take their blood pressure medicine as directed. In fact, 20% to 30% of prescriptions for chronic health conditions are never filled, and about half are not taken as prescribed, reports the Association of American Medical Colleges (AAMC).

Patients’ failure to follow their medical treatment regimens is a common and costly problem with potentially dire consequences. A 2012 study by the American College of Preventive Medicine found that nonadherence accounted for an estimated 125,000 deaths annually and at least 10% of hospitalizations. The repercussions also cost the U.S. health system as much as $300 billion a year, according to a 2014 study by Johns Hopkins University researchers.

Depending on the patient, provider, and situation, contributing factors may include the patient’s social and economic status or education level, the complexity of the treatment and instructions, health system variables, poor provider communication, patient depression or stress, or physical or financial obstacles to drug access.

Patients may also stop taking a medication if they experience unpleasant side effects, are not seeing any immediate benefit from the therapy, or if they simply grow tired of taking pills.

medicine we have a blind spot,” said Victor Montori, M.D., an endocrinologist and professor of medicine at the Mayo Clinic. “Being a patient—especially being a patient with a chronic condition—is a lot of work.” And there’s no curriculum about the work of being a patient, he noted.

Adherence rates haven’t changed significantly in the past three decades, despite efforts by the World Health Organization and the Institute of Medicine to address the problem, according to the American College of Preventive Medicine.

In addition to poorer patient outcomes, hospitals now also suffer the costs of readmission penalties for Medicare patients who return to the hospital because they haven’t followed a doctor’s instructions.

There’s no one-size-fits-all remedy for this problem: physicians and health systems can support adherence in a combination of ways.

At Mayo’s Knowledge and Evaluation Research Unit, Montori focuses on “minimally disruptive medicine” that is designed not to overburden patients. He said clinicians often are unaware of the cumulative effects of what they ask patients to do. Montori noted, for example, that patients may have to go through several bureaucratic steps and pharmacy trips to refill each maintenance prescription.

Montori suggests that healthcare systems focus treatment on the goals patients and clinicians agree to achieve, “and then make sure in the process that we don’t overwhelm [the patients].” In some cases, it’s virtually impossible for patients to do all that their providers ask, Montori says. “Are the treatments, tests, appointments, that we’re asking people to go through, are they really necessary?” he asked. “If we medicalize every moment of their lives, patients will struggle.”

In addition to being more judicious about how many appointments are necessary, the healthcare team can make it easier for patients by trying to bundle appointments or procedures on the same day, he suggests. Or clinicians can help mobilize social resources for patients who need help with housing, food, or addictions—factors that can affect their ability to maintain a treatment regimen, Montori said.

Prescribing more affordable generic drugs, simplifying dosages, synchronizing refills, and finding ways to reduce pharmacy trips may reduce the burden on patients as well, Montori adds. Or, if the patient has stopped taking a medication because of unpleasant side effects, the physician can work with the pharmacist to find an alternative.

At NYU School of Medicine, Adina Kalet, MD, MPH, professor of medicine and surgery and codirector of the Program on Medical Education Innovation and Research, is exploring the use of a Patient Empowerment Program to help patients become more active partners in their care. In a current study, she and colleagues are training patients with diabetes to better communicate with physicians during two two-hour sessions.

So far, said Kalet, “it does what we are hoping it [would do]…. It changes the dynamic in the doctor’s office. We’ve had nothing but positive responses from physicians about how much more satisfying it is to be able to engage as partners with patients.”

For Steven Feldman, MD, PhD, professor of Dermatology, Pathology, and Public Health Sciences at Wake Forest Baptist Medical Center, close follow-up and establishing trust with patients are the keys to patient adherence. Prescribing a drug and then following up in 8 weeks to 12 weeks is not enough to ensure compliance, he says.

“Doctors are the only people on the planet who have the idea that you can tell people, ‘Here, work on this every day and I’ll see you in two or three months.’”

Feldman has found that being a caring provider leads to better patient accountability. When prescribing a new treatment, for example, he writes his mobile phone number on a business card and tells his patient to call in three days to report on progress. “That adds to their trust in me, which adds to their trust in the medicine,” Feldman says.

Wake Forest has spun off a company based on Feldman’s adherence-improvement methods, asking patients to report their treatment status through online surveys. Using that approach, acne patients doubled their adherence to treatments.

Providers may do well to remember that the intangible can be invaluable. “It is the relationship between the doctor and patient that drives the compliance,” says Helen Shields, MD, associate chief of Brigham and Women’s Hospital, Division of Medical Communications.

“I believe strongly that patients are more compliant if they trust you, believe you, and if they can understand what you’re saying.”

Research contact: @AAMCtoday