Niacin for Lowering Cholesterol
Julian Whitaker, MD
Pharmaceutical giant Pfizer was once sitting pretty. Its LDL cholesterol-lowering drug Lipitor was, and continues to be, the best-selling drug in the world, and it was looking to get approval for torcetrapib—an HDL-boosting drug that was expected to be the next blockbuster. Pundits predicted that this one-two punch would dominate the cholesterol and heart disease drug market.
Today, Pfizer’s stock is down, the company has announced plans to close plants and lay off more than 2,000 sales reps, and the $800 million effort to bring torcetrapib to the market is over. The company pulled the plug on the drug after data from a 15,000-patient study revealed that it increased heart problems and death rate.
The idea of raising HDL cholesterol is a good one, but we don’t need a new drug to do it (especially one that kills people). There’s already a therapy out there—an inexpensive B-complex vitamin that not only increases levels of protective HDL cholesterol, but also lowers LDL cholesterol, triglycerides, lipoprotein(a), and other risk factors for heart disease.
A Powerhouse of a Nutrient
Niacin, or nicotinic acid, is a form of vitamin B3 that has been used to lower cholesterol and triglycerides since the late 1950s, decades before statin drugs came on the market.
The first large placebo-controlled trial of the effects of niacin on cardiovascular disease began in 1966. In this study, more than 8,000 men with a history of heart attack took 3,000 mg of niacin or a placebo daily. After six years, the average total cholesterol of the men taking niacin fell by 10 percent, triglycerides by 26 percent, recurrent heart attacks by 27 percent, and strokes by 26 percent more than those in the placebo group. Although there was no difference in the death rate at that time, in a nine-year follow-up period there were 11 percent fewer deaths among those who took niacin.
With a vitamin like this, who needs drugs?
Beyond Total Cholesterol
Not long after this study was published, the race to develop cholesterol-lowering drugs shifted into high gear. Consequently, whenever niacin was studied thereafter, it was as an adjunct therapy along with one drug or another. But even in these studies, niacin shines in ways that no other therapy can.
As discussed earlier, niacin raises HDL cholesterol, which shuttles cholesterol out of the arteries to the liver. A low HDL cholesterol level is an independent risk factor for heart disease, while a high level is protective, even if total cholesterol is above normal. Researchers from the University of Washington recently concluded, based on an analysis of 23 controlled clinical trials, that a 30 percent increase in HDL (which can be achieved with niacin) plus a 40 percent drop in LDL (attainable by using natural therapies as well as statins) adds up to an astounding 70 percent risk reduction—and a “revolution in cardiovascular prevention.”
In addition, niacin favorably affects other blood lipids. It causes a shift away from small, dense LDL cholesterol particles to larger, more buoyant, and less damaging LDL particles. Moreover, it is one of the few proven therapies for lowering lipoprotein(a), another risk factor for cardiovascular disease.
Consider Niacin a Frontline Therapy
Clearly, niacin deserves to be a frontline therapy for cardiovascular disease. Its primary downside is the flushing it can cause when taken in therapeutic doses. Niacin dilates the blood vessels and promotes the release of histamine in the capillaries, resulting in a discomforting warm, tingly, itchy feeling.
You can minimize flushing by taking sustained-release (also called timed-release and controlled-release) niacin, rather than immediate release niacin. (I no longer recommend inositol hexaniacinate, or “no-flush” niacin, for lipid lowering because it doesn’t work as well.) Start with a low dose and build up gradually over the course of a few weeks. Taking it in divided doses with meals also reduces flushing, or you can take it all at once at bedtime so you’ll be asleep if flushing comes on. A baby aspirin (81 mg) or 15–25 mg of Benadryl half an hour before taking niacin at bedtime is helpful as well.
- Most of our patients see benefits with 1,000–2,000 mg daily. High-dose niacin is best taken under the supervision of a doctor. In addition to flushing, other side effects include occasional gastrointestinal distress, skin sensitivity, and rare liver toxicity, so liver enzymes should be checked periodically. High-dose niacin may worsen blood sugar control in diabetics, but with proper monitoring it can be used safely. If you have a peptic ulcer, gout, or liver disease, use with caution.
- Niacin is sold by prescription (Niasafe) and over the counter in drugstores (Endur-Acin). We use OrthoMolecular’s Time Release Niacin at the clinic. To order, call (800) 810-6655.
- Brown BG, et al. Simultaneous low-density lipoprotein-C lowering and high-density lipoprotein-C elevation for optimum cardiovascular disease prevention with various drug classes, and their combinations: a meta-analysis of 23 randomized lipid trials. Curr Opin Lipidol. 2006 Dec;17(6):631–636.
- Canner PL, et al. Fifteen year mortality in Coronary Drug Project patients: long-term benefit with niacin. J Am Coll Cardiol. 1986;8(6):1245–1255.
Modified from Health & Healing with permission from Healthy Directions, LLC. Copyright 2007. Photocopying, reproduction, or quotation strictly prohibited without written permission from the publisher. To subscribe to Health & Healing, click here.