Does niacin lower cholesterol levels?

Introduction

Does niacin lower cholesterol?

There are several options to lower cholesterol. Now I am interested in knowing if niacin (vitamin B3) can lower cholesterol?

Cardiovascular disease is the leading cause of death worldwide, including United States. Coronary artery disease is the number one cause of death. What contributes most to coronary artery disease (CAD)? Obviously dyslipidemia contributes to the development of CAD and other forms of atherosclerosis.

High cholesterol is a major risk factor for heart disease.  If we can maintain cholesterol in normal range the heart disease risk is reduced considerably.

Statistics

1. Individuals with high total cholesterol levels (≥240 mg/dL) have about twice the risk for heart disease.
2. Approximately 100 million adults in the U.S. have total cholesterol levels >200 mg/dL (borderline high).
3. Almost 74 million have high levels of low-density lipoprotein cholesterol (LDL-C).2,3

Treatment options available to lower cholesterol

There are many options to treat dyslipidemia as mentioned below:

1. HMG-CoA reductase inhibitors or statins,
2. Cholesterol absorption inhibitors,
3. Niacin
4. Bile acid sequestrants,
5. Fibrates,
6. Omega-3 fatty acids; and
7. Nutritional Therapy  (Vitamins)

Statins are the mainstay of treatment. In this treatment procedure the amount of cholesterol produced in the body is controlled by synthetic pills called statins. Statins inhibit the synthesis of cholesterol by inhibiting the enzyme HMG-CoA reductase.

Is statin really making less LDL cholesterol in absolute sense?

Body produces less cholesterol because of inhibition of cholesterol synthesis by statins. The amount LDL cholesterol produced is less.

Stains have no control over how liver converts the synthesized cholesterol to different lipoproteins like VLDL, LDL, HDL and triglyceride.

What actually matters is how liver is converting the cholesterol to lipoproteins!

---

Niacin to Lower Cholesterol

There are two ways to use niacin to lower cholesterol. Niacin as monotherapy or niacin along with statins.
Studies conducted by Chapman MJ show that niacin raises HDL levels more efficaciously than fibrtaes.
Niacin is distinguished by its unique capacity to effectively lower Lp(a) levels.

Niacin (Vitamin B3 ):

1. It increases HDL levels by almost 35%;
2. It also reduces LDL levels by upto 25% and
3. Triglycerides by 20 to 50%.

---

Dosage of niacin required to lower cholesterol

This effect is dose related. The dosage required is 1 to 4 gms per day. Immediate release and long acting formulations are available OTC. Sustained release niacin 500 mg tablets are available. See my article best niacin 500 mg tablets on the best brands available in the market.

Do not use nicotinamide in place of niacin because it is ineffective.

---

Niacin side effects

Niacin is associated with several side effects. It can cause hyperglycemia and worsen A1C control, but these increases are often clinically insignificant or readily treatable.

Niacin-induced flushing is a major barrier to its use; this effect limits niacin’s utilization and achievement of therapeutic dosing.

Most patients will experience flushing, which is often more intense with the start of therapy, but usually subsides with continued use. Patients taking immediate-release niacin should be told to gradually increase the dose, take it with meals, and pretreat with aspirin to help minimize the occurrence of flushing

Summary

Niacin is effective in lowering LDL levels, increasing HDL levels as well as lowering Lp(a) cholesterol levels.
Flushing caused by niacin is one of its drawbacks.
Its most import activity is lowering elevated lp(a) levels because lp(a) is the main risk factor of heart disease.
Attempts to develop synthetic pills like PCSK9 inhibitors which lower lp(a) cholesterol is in progress.

---