Treatment with niacin for cholesterol may have gotten some bad press recently, but that has not stopped experts in cardiovascular disease from stepping forward to support its continued use. In a study titled “The current state of niacin in cardiovascular disease prevention: a systematic review and meta-regression,” recently published in the Journal of the American College of Cardiology, Dr. Richard Karas, MD, PhD, Professor of Molecular Medicine at Tufts University School of Medicine, summarizes the effectiveness of niacin for cholesterol improvement and protection from atherosclerosis.

What is niacin?

Niacin is a B vitamin that, when taken at therapeutic  dosage levels, has long been known to raise levels of HDL-cholesterol (the so-called “good” cholesterol). It’s also known to have beneficial effects on various other aspects of cholesterol; it reduces lipoprotein(a), an independent risk factor for cardiovascular disease, decreases the very dangerous small-dense LDL particles, reduces inflammatory markers like C-reactive protein (CRP), improves of endothelial function within the arteries, and reduces inflammation and oxidative stress.

The media’s interpretation of research on niacin for cholesterol is biased

Because considerable risk for cardiovascular disease remains even in people on intensive statin therapy, researchers have recently been studying the effects of statins combined with niacin for prevention of cardiovascular disease. The largest of these trials so far was the AIM-HIGH trial, which stands for “Atherothrombosis Intervention in Metabolic Syndrome with Low HDL/High Triglycerides: Impact on Global Health Outcomes.” AIM-HIGH failed to demonstrate a reduction in cardiovascular disease events in patients who already had established cardiovascular disease and who were being treated with niacin as an add-on to statin therapy. Because of the negative results from the recent AIM-HIGH study, the media has reported “the end” and “the fall” of niacin for cholesterol.

However, Dr. Karas, an expert in preventive cardiology and lipid management, as well as other cardiovascular disease researchers and clinicians from around the world, are aware of the extensive amount of research showing niacin is effective both on its own and as an add-on to statins. Dr. Karas and colleagues therefore designed a study to assess the efficacy of niacin for reducing cardiovascular disease events, such as heart attacks. The researchers looked at the entire body of clinical trial evidence, including data from the AIM-HIGH study. Overall, they identified eleven eligible clinical trials involving 9,959 subjects which examined niacin for cholesterol.

Tufts researchers conclude that evidence supports niacin’s efficacy

After completing their meta-analysis, the researchers confirmed that the collective body of evidence supports the benefits of niacin for cholesterol and prevention of cardiovascular disease. “The recently published findings of AIM-HIGH are insufficient to alter the aggregate available data supporting the clinical efficacy of niacin therapy as a means to reduce cardiovascular disease risk,” the authors concluded.

Who should take niacin for cholesterol?

Anyone with low HDL, high lipoprotein (a), or large amounts of small-dense LDL particles should consider taking niacin for cholesterol-improvement and cardiovascular disease risk reduction. The usual dose of niacin is 500 mg one to three times daily. Taking niacin at these therapeutic levels does present a slight increase in risk of liver damage or increased blood sugar. So anyone using niacin at these levels should have regular labs run by their doctor to check for these conditions. The extended release versions help reduce the likelihood of niacin’s most common side effect: flushing of the skin. In addition to using an extended release version, this flushing can be minimized by taking a baby aspirin daily. However, many people taking regular full release niacin notice that the flushing effect subsides almost entirely after two to three weeks of usage.

Learn more about using niacin for cholesterol: Niacin Among Top Vitamins for Cholesterol with a 60-Year Track Record Proving It Works

Of course, integrative and natural medicine proponents all agree that taking niacin for cholesterol should never be the sole treatment. Holistic, natural treatment that combines other nutrients in supplement form, as well as nutritional and lifestyle therapies, are most effective when utilized in combination. For a comprehensive natural treatment plan for cholesterol, see our full, step-by-step guide here.

[1] J Am Coll Cardiol. 2013 Jan 29;61(4):440-6.