Niaspan for HDL cholesterol

[Hiker in Hawaii]

I asked this on a non-caradic forum once, but would like to get the prospective from a cardioligist...And I have one other question.

I take the max. dose of Niaspan (2000 mgls.) & it is starting to raise HDL, its now 37 from the low 20's...All other lipid levels have been fine, even without medication....On my recent lab, my fasting glucose was 94 (usually it's in 75-85 range)...My question is: can Niaspan in & of itself cause diabetes? (which I think is fasting glucose 126 >)...Have you seen patients have a sharp rise in glucose levels while taking Niaspan...

Also, as someone with a family history (father died of heart attack at 48)...What are good tests someone my age & history should have?....I've heard the caradic catheraztion test is the gold standard for heart testing, but I wouldn't think that test is too practical unless there is a VERY compelling reason to under go it...

Thank you

[Forum-M.D.-MM]

Hello,

One of the listed potential adverse events of Niaspan is hyperglycemia.  I would not worry about a blood sugar of 94 though.  That is still pretty low.

The indication for cardiac testing is symptom and probability driven.  If you are not having symptoms of cardiac disease, I would not order tests like exercise stress, CT, MRI, cardiac cath, nuclear studies unless there was a clear indication.  It is reasonable to do lipid panels, blood pressure checks, and other very non invasive risk stratifcation.  Ordering tests without a clear indications is inviting false positive results that could esculate to more unnecessary testing.

Thanks for posting.

[davidc]

Excuse me, but if you are already having cardiac symptoms, isn't it a little late in the game to start testing? Testing at that time would be good for differential diagnosis - that is, to determine if the symptoms are actually cardiac-related. But the cow is already out of the barn! Wouldn't be better to know, say, a decade before a big problem developed that a problem was developing? For folks whose parents had heart disease at an early age, wouldn't it be prudent to do some testing before a problem developed, even if false positives were encountered that needed to be shown false through further testing?  Yes, such testing is more costly, but what if by testing early you prevented the need for say, a quadruple bypass later?

[Hiker in Hawaii]

I'm NOT having any symptoms, I just have a pre-disposition to heart disease since my father died at 48...

[EchoTech]

You have to measure how much potential help and whether or not it is worth the potenial harm that a procedure can have on a person.  Even though procedures like catherizations are pretty common, they still come with risks, including serious debilitation and death.  Say you had a stress test that was a false positive.  The next step is a catherizaion which comes with those risks.  It is not stuff that you just want to do for the heck of it, it can have bad consequences. Would you be willing to risk your life or health with a 3% to 5% risk of a serious complication just because ?
  As far as predicting how things are going to play out down the road in ten years, nobody can predict it.  There are only probabilities.  Some people get plaque in their arteries or have a valve with a moderate leak, and they stay the same way for decades, while others deterioate in a matter of a couple years.

The easiest thing to do is change the risk factors that you can by exercising, eating right, getting enough sleep and do not smoke.  Some people are going to have events no matter how they change their risk factor becasue it is genetic, while ohters can change their outcome  tomorrow by taking the right steps today.

Good night and good luck.

[davidc]

Yes, I understand that testing carries risk - The cath, for instance, and that testing shouldn't be done if risk to the patient is high. But there is less invasive testing available - the cardiac CT scan, for instance, which could give you a better indication of cardiac risk than blood lipid panels and could be used subsequent to a false positive stress test. You could also have a stress echo, which would be a step up.

As far as lifestyle changes, yes, everybody should have a healthy lifestyle, but what about draconian changes like an Ornish-style, < 10% calories from fat diet? I would only want to go to this extreme if I had good evidence, through tests, that I needed to to prevent incipient heart disease.

Anyway, I am generally a little skeptical about claims that tests are unnecessary, due to the huge financial incentives insurance companies have to limit testing, and the pressures they place on physicians to limit costs. The determination of what is necessary or not can become dominated by the cost of the test, rather than the risk/reward to the patient - which, as a patient, is where I want it to be.

[anacyde]

To test everyone for a 'maybe' would drain medical resources to a point that people who really need help wouldn't be getting it.  It's overkill.  When weighing risk versus benefit, it's far more beneficial (to everyone) to test people when there's a suspected problem or a very strong family history.  Testing when symptoms appear doesn't make treatment less effective.  Ignoring symptoms for days, weeks, months and years is what makes treatment less effective.  

And as they say, an ounce of prevention is worth a pound of cure.  We just all need to do everything we can to modify our risks, see our doctors regularly for our physicals and blood work, exercise and, if something arises, report it.

[Schmoomcgoo]

An EKG is a simple, inexpensive and very informative test that makes sense to have.  It can provide a baseline for any number of changes to the structure and conductivity of one's heart.  Also, a practitioner who is handy with a stethescope can detect sounds that can point to potential problems.  My comments are rather predictably colored with the suspicion of valvular heart disease and aortic aneurysm, because that's my particular brand of medical angst, but "heart attack" is a specific term that is/was often applied to any ill that seems cardiac in nature, particularly decades ago.  I therefore think it's prudent to keep an ear out for telltale extra heart sounds and monitor, in particular, the size of the heart as it is inexpensive to do so and can provide much valuable information.

In all fairness, as an Ornish vegetarian, I should confess that I do ascribe to "draconian" ideas of dietary impact on cardiac health.  One with worries such as yours could do worse. ;)

[Hiker in Hawaii]

I asked my MD once, can you really detect anything from just listening w/the stehoscope? (spelling) & he said you definitely can...I mean, he said you CAN'T detect very early heart disease, but a if a MD has a good trained ear, some abnormalities can certainly be picked up....

[michael in atlanta]

You may be interested in this: five years ago, just for the heck of it, I had a LifeTest calcium scan. I was about 70 then - had been exercising regularly for 35 years. No cardiac symptoms. Weight normal, heart-healthy diet for many years, no heart disease in the family. My cholesterol 235. The test showed an Agatston score of about 1400! Needless to say I went immediately to a cardiologist who put me on Zocor 40 and Niaspan 2000. I had a nuclear stress test - reached pulse of 171 (about 13 minutes) -normal except for exercise-related ST-segment depression.

Later, a VAP test revealed Lp(a) of 39 - probably the culprit.

Over the last four years, despite getting my TotalC down to 115, my LP(a) down to about 13, LDL-C <60, and my triglycerides <30, the calcium score has continued to rise. The last scan, in December, it read 2,400. Still exercycling  45 min 5x per week, to peak pulse rate around 155.

Bottom line, if I had not had the LifeTest I might have been one of the 50% of folks who drop dead of a heart attack with no prior symptoms.