Niacin (a B vitamin) is not often thought of as a medication, especially by pharmaceutical companies that can't profit from its use. However, this reasonably priced vitamin has demonstrated better overall results than cholesterol-lowering drugs in decreasing the risk of coronary heart disease (CHD).
In the 1950s, niacin was first described as having cholesterol-lowering activity. Today, it is known to do much more than just lower total cholesterol levels. It has been shown to lower LDL (bad) cholesterol, raise HDL (good) cholesterol and lower triglyceride levels, as well as lower Lp(a) and fibrinogen levels. Lp(a) - lipoprotein a - is a type of cholesterol ("apolipoprotein a" attached to LDL cholesterol) that is usually inherited, and fibrinogen is a blood protein that causes clot formation.
In a 26 week study, niacin was compared to the drug lovastatin. The study involved 136 participants who had CHD and LDL levels greater than 160 mg/dl, and/or more than two CHD risk factors, or LDL levels greater than 190 mg/dl without CHD or with few CHD risk factors. A higher percentage of those who took lovastatin had a greater reduction in LDL levels, but a higher percentage of those who took niacin had better results with HDL and Lp(a) levels (a low HDL level is actually a more significant indicator for CHD). The following are the results between the two groups:
LDL cholesterol reduction
• lovastatin - 26 percent at 10 weeks, 28 percent at 18 weeks, 32 percent at 26 weeks
• niacin - 5 percent at 10 weeks, 16 percent at 18 weeks, 23 percent at 26 weeks
HDL cholesterol increase
• lovastatin - 6 percent at 10 weeks, 8 percent at 18 weeks, 7 percent at 26 weeks
• niacin - 20 percent at 10 weeks, 29 percent at 18 weeks, 33 percent at 26 weeks
Lp(a) lipoprotein reduction
• lovastatin - zero percent at 10 weeks, zero percent at 18 weeks, zero percent at 26 weeks
• niacin - 14 percent at 10 weeks, 30 percent at 18 weeks, 35 percent at 26 weeks
High doses are needed for treatment, which can cause a harmless but uncomfortable flushing of the skin. The flushing is temporary and typically occurs 20 to 30 minutes after taking niacin. Other occasional side effects include nausea, gastric irritation, headache, dizziness, increased blood sugar and liver damage. Diabetics should be closely monitored, and people with elevated liver enzyme levels or a preexisting liver disease should avoid use.
To help prevent flushing, some manufacturers began marketing "slow-release", "timed-release" or "sustained-release" products. These absorb gradually, reducing the flushing reaction. However, according to a study published in JAMA, 52 percent of those who took these products developed liver toxicity, and none of those who took regular niacin developed liver toxicity.
If you are considering taking niacin as a treatment, consult your doctor first. Cholesterol and liver enzyme levels should be monitored.