Niacin Raises “Good” Cholesterol Levels

Adding relatively small amounts of niacin (a form of vitamin B3) to a standard cholesterol-lowering drug regimen led to a significant improvement in HDL (“good”) cholesterol levels, an important predictor of heart disease risk, according to a study in the American Heart Journal.¹

In the new study, people taking one of a class of cholesterol-lowering medications known as “statin drugs” were randomly chosen to receive either 100 mg of niacin per day or placebo. In the people receiving niacin, HDL cholesterol levels increased by an average of 5%, compared with a slight decrease in the placebo group; the difference between groups was statistically significant. This increase in HDL levels is considered a beneficial change, since high levels of HDL are associated with a reduced risk of heart disease. Niacin did not cause any major side effects, and only 20% of the patients experienced the typical “niacin flush,” a sensation of itching and burning of the skin that often accompanies high-dose niacin therapy.

Niacin supplementation in amounts of 3 grams per day or more has been found to be effective in reducing LDL (“bad”) cholesterol and increasing HDL. Smaller amounts, such as 1 gram per day, are less effective. Unfortunately, in addition to flushing, large amounts of niacin can cause significant side effects, including high blood sugar and liver damage. These side effects have limited the usefulness of niacin as a lipid-lowering agent. The new study is noteworthy in that a comparatively small amount of niacin produced a beneficial effect, when combined with a prescription cholesterol-lowering drug.

Although the dangers of high cholesterol are well understood by the public, little attention has been paid to the dangers of low HDL cholesterol. In younger people, low HDL cholesterol may be the most important predictor of heart disease.² In addition to taking niacin, losing weight, engaging in aerobic exercise, and quitting smoking may be helpful for increasing HDL concentrations.^{3 4}

The drugs of the statin class are the medical treatment of choice for high cholesterol. These drugs effectively reduce LDL cholesterol, but are not thought to have beneficial effects on HDL cholesterol. Because of this, researchers have looked for medications that raise HDL to add to statin treatment.

The change in HDL in the new study, though small, may have a dramatic effect on heart disease incidence. One study found that a 6% increase in HDL (similar in magnitude to that reported here) led to a 22% reduction in the incidence of fatal and nonfatal heart attacks.⁵

Previous studies that attempted to pair statin drugs with niacin treatment used large amounts of niacin that were associated with evidence of liver damage.^{6 7} Given the efficacy and safety demonstrated with low intake levels of niacin, it would appear to be a heart-smart recommendation for patients on statin therapy.

References:

1. Wink J, Giacoppe G, King J. Effect of very-low-dose niacin on high-density lipoprotein in patients undergoing long-term statin therapy. Am Heart J 2002;143:514–8.
2. Genest JJ Jr, Martin-Munley SS, McNamara JR, et al. Familial lipoprotein disorders in patients with premature coronary artery disease. Circulation 1992;85:2025–33.
3. Glueck CJ, Taylor HL, Jacobs D, et al. Plasma high-density lipoprotein cholesterol: association with measurements of body mass: the Lipid Research Clinics Program Prevalence Study. Circulation 1980;62 Suppl IV:S62–S9.
4. Dwyer JH, Rieger-Ndakorerwa GE, Semmer NK, et al. Low-level cigarette smoking and longitudinal change in serum cholesterol among adolescents. JAMA 1988;259:2857–62.
5. Rubins HB, Robins SJ, Collins D, et al. Gemfibrozil for the prevention of coronary heart disease in men with low levels of high-density lipoprotein cholesterol. N Engl J Med 1999;341:410–8.
6. Davignon J, Roederer G, Montigny M, et al. Comparative efficacy and safety of pravastatin, nicotinic acid and the two combined in patients with hypercholesterolemia. Am J Cardiol 1994;73:339–45.
7. Jacobson TA, Chin MM, Fromell GJ, et al. Fluvastatin with and without niacin for hypercholesterolemia. Am J Cardiol 1994;74:149–54.

Matt Brignall, ND, is in practice at the Seattle Cancer Treatment and Wellness Center and at the Evergreen Integrative Medicine Clinic in Kirkland, WA. He specializes in integrative treatment of cancer. He is a contributor to Healthnotes and Healthnotes Newswire.

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