From the Guidelines
Niacin, also known as Vitamin B3, can be beneficial for managing hypercholesterolemia, particularly in patients with high triglycerides or low HDL-C, as it can raise HDL cholesterol and lower LDL cholesterol and triglycerides. When considering niacin for cholesterol management, it is essential to consult with a healthcare provider first, as they may recommend starting with a low dose and gradually increasing it while taking it with meals to minimize side effects 1. Niacin works by inhibiting an enzyme in the liver that produces cholesterol and by slowing the breakdown of HDL cholesterol. Some key points to consider when using niacin for hypercholesterolemia management include:
- Prescription-strength niacin (typically 1-3 grams daily) can raise HDL cholesterol by 15-35% and lower LDL cholesterol by 5-25%, while also reducing triglycerides by 20-50% 2.
- Niacin should only be taken at these therapeutic doses under medical supervision due to potential side effects like flushing, itching, liver problems, and increased blood sugar.
- Over-the-counter niacin supplements are not recommended for self-treatment of cholesterol issues.
- Other cholesterol-lowering strategies like statins are typically preferred as first-line treatments.
- For high-risk patients, the recommended LDL-C treatment goal remains at < 100 mg/dL, but a target of < 70 mg/dL represents a therapeutic option for persons considered to be at very high risk 1. It is crucial to weigh the benefits and risks of niacin therapy and consider individual patient factors, such as medical history, current medications, and lifestyle, when deciding whether to use niacin for hypercholesterolemia management.
From the FDA Drug Label
To reduce elevated TC, LDL-C, Apo B and TG, and to increase HDL-C in patients with primary hyperlipidemia and mixed dyslipidemia. As an adjunct to diet to reduce elevated TC and LDL-C in adult patients with primary hyperlipidemia.
Niacin (Vitamin B3) is beneficial for managing hypercholesterolemia. It is indicated to reduce elevated total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and to increase high-density lipoprotein cholesterol (HDL-C) in patients with primary hyperlipidemia and mixed dyslipidemia 3. Additionally, it can be used as an adjunct to diet to reduce elevated TC and LDL-C in adult patients with primary hyperlipidemia. Key benefits include:
- Reduction of elevated TC, LDL-C, Apo B, and triglycerides (TG)
- Increase in HDL-C
- Slowing progression or promoting regression of atherosclerotic disease in patients with a history of coronary artery disease (CAD) and hyperlipidemia 3
From the Research
Benefits of Nicotin (Vitamin B3) for Hypercholesterolemia
- Nicotin (Vitamin B3) has been shown to positively modify lipid disorders, including elevated LDL cholesterol, non-HDL cholesterol, triglycerides, lipoprotein(a), and reduced HDL cholesterol 4, 5, 6.
- It has been demonstrated to reduce coronary death and non-fatal myocardial infarction, and all-cause mortality in long-term follow-up 5.
- Niacin increases HDL cholesterol and reduces total cholesterol, LDL cholesterol, and triglycerides 5, 6.
- It also favorably influences other lipid parameters, including lipoprotein(a), alimentary lipemia, and small dense LDL 5, 6.
Considerations for Use
- Niacin may be useful as an additive to statin therapy or as a substitute for statin-intolerant patients 4.
- Patients with elevated triglyceride and low HDL cholesterol levels, and those with elevated lipoprotein(a) concentrations, may benefit from niacin therapy 4, 6.
- However, possible side effects, such as flushing, liver damage, and contraindications, should be taken into consideration 4, 5, 7.
- The use of prescription niacin products is recommended over dietary supplement niacin products due to differences in regulatory standards and clinical efficacy 8.