How vitamin pills could save you from a heart attack

Lifesavers? A new treatment for heart disease could be a simple vitamin tablet

Cholesterol famously comes in two versions - the good and the bad. Heart health, we're told, depends on lowering the bad (LDL) cholesterol, and pushing up the good (HDI).

But it's no longer that simple. Bad cholesterol turns out to be part of a double act.

What's more, this discovery suggests that a new treatment for heart disease could be a simple vitamin tablet.

Researchers recently found that bad cholesterol has a twin called lipoprotein(a), which can also raise your risk of heart disease.

Having both of them would be a double whammy and raise the risk of blocked arteries even further.

Doctors have known for some time that people with a high level of Lp(a), as it is known, were more likely to have a heart attack or a stroke.

What wasn't certain was whether it could cause them or whether it was an innocent bystander.

Now, researchers have found a definite link between higher levels of lp(a) and cardiovascular problems.

'The work confirms unequivocally that Lp(a) is a causal factor for coronary heart disease,' says Dr Robert Clarke, of the Clinical trial service Unit at oxford University.

'The increased risk from high levels is only about a quarter the risk from lDl, but the hope is that by targeting both we will be able to reduce people's risk even further.'

Exactly why Lp(a) raises the risk of cardiovascular disease isn't clear yet, but it probably makes clots more likely. That's because it has another protein attached to it that helps clots form over damage to the arteries.

Your levels of Lp(a) are thought to be more the result of your genes than anything else. The good news is that it seems to respond to a number of different vitamins and supplements, the best known of which is the B vitamin niacin.

'Niacin is a fantastic all-round treatment for protecting hearts,' says Dr Sarah Jarvis, of the royal College of GPs. 'It brings down both LDL and Lp(a) and it also pushes up HDL.'

Is found naturally in liver, poultry and fish, although the best sources are wholegrains, nuts and dried beans. However, patients who are treated with niacin are usually given a 2g supplement a day - far more than you could get from food.

The problem with niacin supplements says Dr Jarvis, is the side-effect of 'flushing', in which the blood vessels dilate, making the skin blush and prompting a burst of warmth: 'Most patients can't tolerate it because it makes you flush very strongly. I get few repeat prescriptions with niacin.'

However, there is a new form of niacin that could get round this. Tredaptive has an added ingredient that blocks the chemical in niacin that normally causes flushing. (Tredaptive is now available on the NHS.)

But niacin isn't the only vitamin to bring down Lp(a). According to some clinicians, it also responds to other familiar supplements, such as vitamin C and fish oil.

Wendy Denning, a private GP working in London, often combines niacin with vitamin C for patients with raised levels of Lp(a).

So should we all have our Lp(a) levels tested right away? Most of the experts believe that it is too early for that.

'A lot of research still needs to be done,' says Dr Clarke. 'We'll have to do trials to prove that lowering it actually makes a difference, and we need to know more about how it harms the heart.'

JarvIs says she wouldn't usually test for Lp(a) unless she was faced with a puzzle.

'The familiar risk factors of high lDl - being overweight, smoking and so on - are pretty good predictors of high LP(a),' she explains.

'But if I had a patient who had a high risk from his family history, but all his other markers were surprisingly healthy, I might check out his Lp(a) to see if there was a hidden risk there."

The test can be carried out privately. But while there might not be a consensus on universal testing, there is no doubt that we have a new target to reduce heart disease risk.

'In ten years there may be a much wider range of targets that we can test and treat,' says Dr Jarvis. 'That should mean we'll be able to handle heart disease more effectively.'