Five lessons from the Niacin failure

This week the New England Journal of Medicine published two studies on the role of niacin in preventing future cardiac events. The short story is that niacin was ineffective and associated with significant harm. A number of excellent summary pieces have been written, and I will reference them at the end. The purpose of writing my thoughts on this matter is to put these unsurprising results into a larger context of health, and also to consider the changing role of the physician. Lesson 1: Association does not equal causation For years, medical experts have observed that patients with high HDL levels (good cholesterol) had lower rates of cardiac events. It made sense because HDL serves as a sort of cholesterol scavenger agent—the more HDL one has the less cholesterol available to get deposited in the artery. So it is mostly true that high HDL levels associate with good outcomes. That is much different than saying high HDL levels cause good outcomes. The niacin failure, taken together with failures of many other potent HDL-raising drugs, strongly suggest that the relationship of high HDL and good outcomes is not causal. HDL may be a risk marker but it is not a risk factor. This theme will come up again in Lesson 3. Lesson 2: Be careful with surrogate markers You might wonder how niacin, a drug with such lousy results, got so well established in medical practice. The simple answer is that we thought moving numbers on lab tests would improve future outcomes. Niacin, like many o...
Source: Dr John M - Category: Cardiology Authors: Source Type: blogs