If your HDL cholesterol is low and you’re taking a statin, the question of whether to take niacin may hinge on your LDL level. Your doctor may want you to add niacin if your LDL level is high, but not if it's low.

Another factor to consider: The people in the National Heart, Lung, and Blood Institute (NHLBI) niacin trial already had heart disease. If you don't have heart disease, your doctor may be less likely to prescribe niacin since it may not provide enough of a benefit to warrant the uncomfortable—and sometimes intolerable—side effect of flushing. Flushing can cause burning, tingling, itching and redness of the face, arms and chest. (Taking aspirin 30 minutes before niacin may lessen flushing.) Niacin can also cause other side effects, such as gout and liver abnormalities.

However, if you're at high risk for a heart attack but can’t take a statin—perhaps you're allergic to statins or you experience intolerable side effects—then niacin may be a good option.

Stroke Risk?

Besides disappointing findings, another reason that prompted the NHLBI to end AIM-HIGH early was that a small number of participants taking niacin suffered unexplained ischemic strokes. Ischemic strokes occur when arteries to the brain become blocked by a clot (thrombus).

Although the strokes couldn't be directly linked to the niacin, researchers decided to take no chances, particularly since they were confident that continuing the study would likely not produce different outcomes than those measured so far. Researchers suspect that the strokes were just a statistical fluke, but the possibility that the drug might be harmful—in combination with no evidence that it was beneficial—helped them decide to cut AIM-HIGH short.

Further studies will be needed to examine any connection between niacin and stroke.

More Research to Come

Meanwhile, health care professionals are looking forward to the results of a similar but much larger study examining the benefits of extended-release niacin on heart health: Since 2007, researchers at Oxford University have been conducting an international trial called HPS2-THRIVE. More than 25,000 people ages 50 to 80 have been recruited for the study. HPS2-THRIVE is slated to conclude in 2013.

Doctor's Viewpoint

James L. Weiss, M.D. Michael J. Cudahy Professor of Cardiology, Johns Hopkins University School of Medicine

The AIM-HIGH trial participants had low LDL cholesterol when the study started, which may account for the lack of additional benefit from niacin. The study doesn't show niacin's effect on people with high LDL cholesterol. Plus, these results are preliminary and still need to be published and examined. We shouldn’t discount the benefits of niacin until more information is in.

The best way to increase HDL cholesterol is by adding 30 minutes of activity to your day, eating healthful meals and avoiding trans fats so you can reduce or eliminate the need for drugs.

Source: Prepared by the Editors of The Johns Hopkins Medical Letter: Health After 50

Publication Review By: the Editorial Staff at Healthcommunities.com

Published: 07 Jul 2013

Last Modified: 18 Sep 2015