Niacin, also known as nicotinic acid or vitamin B3, is a water-soluble vitamin that reduces cholesterol and other circulating lipids. High blood cholesterol and lipids substantially increase the risk of developing heart disease. A review by Dr. Terry Jacobson in the April 2010 issue of "Mayo Clinic Proceedings" reports that niacin therapy lowers the risk of heart attack by 27 percent. The American Heart Association says that dietary supplements contain variable amounts of niacin and are not regulated by the Food and Drug Administration. For these reasons, over-the-counter niacin supplements should not be used in place of the prescription form of niacin.
Dereases LDL
Low density lipoproteins, also known as LDL cholesterol and "bad cholesterol," are molecules that transport the cholesterol that is either absorbed during digestion or produced by the liver, bringing it to other sites in the body. A higher level of LDL cholesterol in the blood substantially increases the risk of heart disease. According to the American Heart Association, levels of LDL in the blood below 100 mg/dL are optimal for reducing the risk of heart disease. A review in the August 2007 issue of "Vascular Health Risk Management" reports that in clinical trials, niacin therapies reduced LDL cholesterol, on average, 12 percent.
Increases HDL
High density lipoproteins, commonly referred to as HDL, are the so-called "good cholesterol" because the molecules transport excess cholesterol from cells in the body back to the liver so that it can be excreted in the bile or used by other tissues for the synthesis of steroid hormones. The American Heart Association says that HDL levels below 40 mg/dL increase the risk of heart disease. A review in the August 2010 issue of the "International Journal of Women's Health" reports that niacin therapy typically increases HDL cholesterol between 15 and 35 percent.
Combination Therapy
An article in the March 2009 issue of "The American Journal of Managed Care" reports that people taking statin drugs, which are effective in reducing LDL cholesterol, still are at risk of cardiovascular disease mainly because of low HDL cholesterol and elevated triglycerides. This source recommends niacin therapy in combination with a statin drug to treat abnormal lipid profiles and more effectively reduce the risk of heart disease.
Dosing
The review in the "Mayo Clinic Proceedings" advocates a slow increase in niacin dosing in the first eight weeks, beginning with 0.5 g and ending with 1 g, followed by a single-step increase to 2 g after eight weeks.
Side Effects
Dr. Terry Jacobson reports in the "Mayo Clinic Proceedings" that between 5 and 20 percent of people taking niacin discontinue its use because of flushing. Flushing refers to a sense of warmth in the face and neck, and more rarely the extremities, and may include redness and itching. Niacin therapy almost always causes flushing, but this side effect typically subsides with continued use. Dr. Jacobson says that flushing can be prevented by slowly increasing the dose of niacin, taking niacin at mealtimes or at bedtime, and taking 325 mg of aspirin 30 minutes before the niacin.
References
- "Vascular Health Risk Management"; Prolonged-Release Nicotinic Acid for the Management of Dyslipidemia: An Update Including Results from the NAUTILUS Study; Anja Vogt et al.; August 2007
- "Mayo Clinic Proceedings"; A "Hot" Topic in Dyslipidemia Management---"How to Beat a Flush": Optimizing Niacin Tolerability to Promote Long-term Treatment Adherence and Coronary Disease Prevention; Terry A. Jacobson; April 2010
- American Heart Association: Good vs. Bad Cholesterol
- American Heart Association: Cholesterol-lowering Studies
- "International Journal of Women's Health"; Raising HDL Cholesterol in Women; Danny J. Eapen et al.; August 2010
- "The American Journal of Managed Care"; Beyond LDL Cholesterol: The Role of Elevated Triglycerides and Low HDL Cholesterol in Residual CVD Risk Remaining After Statin Therapy; P. Alagona; March 2009
