You are here:

New thinking on niacin use

Image: Thinkstock

A typical dose is 1.5 to 2 grams, far larger and riskier than the RDA of 15 milligrams per day.

Using niacin to raise “good” cholesterol doesn’t lower your risk of having a heart attack or stroke.

If your LDL, or “bad” cholesterol, is under control, but you’re still taking the B vitamin niacin in attempt to raise your HDL, or “good” cholesterol, you may need to reassess your medication regimen. “The issue of using niacin to raise HDL is closed. We aren’t using it anymore,” says cardiologist Dr. Linda Hemphill, who specializes in managing cholesterol for high-risk patients at Harvard-affiliated Massachusetts General Hospital.

Old theory

At one time, the only way to effectively lower LDL was a combination of high-dose niacin and bile acid sequestrants. A well-known study led by Dr. David Blankenhorn and Dr. Hemphill called the Cholesterol-Lowering Atherosclerosis Study showed that this combination could lower LDL by 43% and raise HDL by 37%.

Then statins came along in 1987. “With potent statins, you can get a 50% or more reduction in LDL,” says Dr. Hemphill. That’s made statins such as atorvastatin (Lipitor) and rosuvastatin (Crestor) the medications of choice to lower LDL cholesterol.

But for people with low HDL levels, niacin has continued to be prescribed in addition to a statin as a way to boost HDL, even when LDL levels are under control. The theory has been that raising HDL could ward off both heart attack and stroke.

New approach

In the past few years, however, a number of studies—most notably the AIM-HIGH study from the National Institutes of Health—have shown that raising HDL by taking niacin does not protect patients from cardiovascular events. “While lowering LDL by any means reduces cardiac events, the hypothesis that raising HDL also has a benefit has simply not worked out,” says Dr. Hemphill.

And niacin comes with many risks, even though it’s a natural vitamin (B3). A rapidly absorbed and metabolized form, called crystalline niacin, must be taken two or three times a day. It may cause itching, facial flushing, and headaches. “It may trigger gout, or it may cause gastrointestinal bleeding, liver damage, or diabetes in people who have a borderline-high blood sugar,” says Dr. Hemphill.

Slow-release or sustained-release niacin isn’t as likely to cause flushing and itching, but it still may cause the other, more serious problems mentioned above.

What you should do

Despite side effects, niacin is still considered useful as an add-on therapy in people whose LDL is not lowered enough by statins alone—particularly patients with a rare condition called severe familial hypercholesterolemia. “It’s a good alternative when statins are not effective,” says Dr. Hemphill. But don’t attempt to use niacin without your doctor’s supervision.

The typical dose is usually 1.5 to 2 grams, which is far larger and riskier than the Recommended Dietary Allowance of around 15 milligrams per day for adults.

And what if your doctor is not following the latest shift in niacin thinking? Have a chat and ask if raising your HDL is really worth the risk of niacin’s potential harms.  

Posted by: Dr.Health

Back to Top