In a large clinical study called AIM-HIGH (for Atherothrombosis Intervention in Metabolic Syndrome with Low HDL/High Triglycerides and Impact on Global Health Outcomes), researchers evaluated the impact of extended release niacin (vitamin B3) on blood lipids. In a previous review of patients in this AIM-HIGH trial, niacin showed no benefit to statin-treated patients when analyzed as a whole group. However, in a subsequent analysis, niacin appeared to benefit patients who had high triglycerides (over 200 mg/dL) and very low HDL (less than 32 mg/dL). In this analysis, the authors sought to find out the specific changes in lipoproteins that conferred the benefit seen in the subset of patients with high triglycerides and low HDL.
Lipoprotein particles were analyzed on 2457 participants in the AIM-HIGH trial to establish baseline values and again after one year of treatment with extended release niacin. Those taking niacin had higher HDL after one year (a good outcome since HDL is protective). In addition, the analysis of lipoprotein subfractions showed that this benefit – specific to people with high triglycerides and low HDL – was likely due to the reduction in remnant lipoproteins, also known as RLP.
This unique lipoprotein is particularly harmful because unlike LDL particles, which have to undergo oxidation before they can be taken into the arterial intima, RLP lipoproteins can be readily transformed into foam cells which is what comprises arterial plaque. In fact, RLP is one of the four major risk factors cited by the National Cholesterol Education Program that contribute to heart disease. This paper suggests that the benefit seen in patients taking niacin was due to a reduction in this particularly harmful lipoprotein called RLP.
Micronutrients are involved in the body’s countless metabolic reactions; therefore, a single deficiency can affect cardiac and metabolic health. Regardless of your medical history and current health, micronutrient testing in combination with our CardioMetabolic evaluation can help your health care provider identify your risk and design a personalized treatment plan for you.
(Journal of Clinical Lipidology, May 2018)
LINK to ABSTRACT Relationship between lipoprotein subfraction cholesterol and residual risk for cardiovascular outcomes: A post hoc analysis of the AIM-HIGH trial.