It’s frustrating, but most scientific studies end with the line, “more research is needed.” But not always. We have one of these rare cases in a study published in the New England Journal of Medicine about the use of niacin to improve cholesterol profile. Niacin is familiar to many as the B vitamin that prevents pellagra but when it is used to decrease LDL (the “bad” cholesterol) and increase HDL (the “good” cholesterol) it is given in far higher doses than the amount that prevents pellagra. At a dose of 1000 mg a day, niacin is a drug. It has been used for decades in people with cholesterol problems because it clearly does decrease LDL and increases HDL. But that is not the same as reducing cardiac events. Now we have a study that quite categorically shows that in spite of the impact on cholesterol levels, niacing does not reduce cardiac events. Furthermore, it complicates diabetes and results is an increased risk of gastrointestinal, musculoskeletal and dermatological problems.
This was a very well designed study of some 25,000 people who were taking statin drugs because of cardiac risk. They were properly randomized to take a placebo or time-released niacin in combination with laropripran, added to reduce the classic flushing side effect of niacin, After four years the results were definitive. No reduction in cardiac events and an increase in side effects. No doubt the “natural treatment” advocates will declare that this study was contrived by Big Pharma to show that natural therapies do not work. Of course at doses needed to alter blood cholesterol, niacin can hardly be called natural. We’ll see how many of the websites that promote niacin for reducing cardiac risk will change their sales pitch. Will Dr. Agatston change his mind? How about Dr. Oz who also recommends taking 400 mg of niacin a day. And Joe Mercola, who wildly promoted niacin on Dr. Oz’s show while telling people to stay away from statins? Will be interesting to see.