Niacin for cholesterol Information | Mount Sinai

Antilipemic agent; Vitamin B3; Nicotinic acid; Niaspan; Niacor; Hyperlipidemia – niacin; Hardening of the arteries – niacin; Cholesterol – niacin; Hypercholesterolemia – niacin; Dyslipidemia – niacin

How Niacin Helps

Improving your cholesterol levels can help protect you from:

• Heart disease
• Heart attack
• Stroke

Your health care provider will work with you to lower your cholesterol by improving your diet. If this is not successful, medicines to lower cholesterol may be the next step. Statins are thought to be the best drugs to use for people who need medicines to lower their cholesterol.

Research now suggests that niacin does not add to the benefit of a statin alone for reducing the risk of cardiovascular events, including heart attacks and stroke.

In addition, niacin can cause unpleasant and potentially dangerous side effects. Therefore, its use has been declining. However, some people may be prescribed niacin in addition to other drugs if they have very high cholesterol or if they do not tolerate other medicines.

Which Niacin Medicine is Right for you?

There are different brands of niacin medicines. Most of these also come in a less expensive, generic form.

Niacin may be prescribed along with other medicines, such as a statin, to help lower cholesterol. Combination tablets that include nicotinic acid plus other medicines are also available.

Niacin is also sold over-the-counter (OTC) as a supplement. You should not take OTC niacin to help lower cholesterol. Doing so could have serious side effects.

How to Take Niacin

Take your medicine as directed. The medicine comes in tablet form. Do not break or chew tablets before taking the medicine. Do not stop taking your medicine without talking with your provider first.

You take niacin 1 to 3 times per day. It comes in different doses, depending on how much you need.

Read the label on the pill bottle carefully. Some brands should be taken at bedtime with a light, low-fat snack; others you will take with dinner. Avoid alcohol and hot drinks while taking niacin to reduce flushing.

Store all of your medicines in a cool, dry place. Keep them where children cannot get to them.

You should follow a healthy diet while taking niacin. This includes eating less fat in your diet. Other ways you can help your heart include:

• Getting regular exercise
• Managing stress
• Quitting smoking

Know Your Risks

Before you start taking niacin, tell your provider if you:

• Are pregnant, plan to become pregnant, or are breastfeeding
• Have allergies
• Are taking other medicines
• Drink a lot of alcohol
• Have diabetes, kidney disease, peptic ulcer, or gout

Talk to your provider about all of your medicines, herbs, or supplements. Certain medicines may interact with niacin.

Regular blood tests will help you and your provider:

• See how well the medicine is working
• Monitor for side effects, such as liver problems

Possible Side Effects

Mild side effects may include:

• Flushing and red face or neck
• Diarrhea
• Headache
• Upset stomach
• Skin rash

Though rare, more serious side effects are possible. Your provider will monitor you for signs. Talk with your provider about these possible risks:

• Liver damage and changes to liver enzymes
• Severe muscle pain, tenderness, and weakness
• Heartbeat and rhythm changes
• Changes in blood pressure
• Severe flushing, skin rash, and skin changes
• Glucose intolerance
• Gout
• Vision loss or changes

When to Call the Doctor

You should call your provider if you notice:

• Side effects that are bothering you
• Fainting
• Dizziness
• Fast or irregular heartbeat
• Yellow skin or eyes (jaundice)
• Muscle pain and weakness
• Other new symptoms

American Heart Association website. Cholesterol medications. www.heart.org/en/health-topics/cholesterol/prevention-and-treatment-of-high-cholesterol-hyperlipidemia/cholesterol-medications. Updated November 11, 2020. Accessed May 3, 2022.

Genest J, Mora S, Libby P. Lipoprotein disorders and cardiovascular disease. In:  Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 27.

Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2019;73(24):3234-3237. PMID: 30423391 pubmed.ncbi.nlm.nih.gov/30423391/.

Guyton JR, McGovern ME, Carlson LA. Niacin (nicotinic acid). In: Ballantyne CM, ed. Clinical Lipidology: A Companion to Braunwald’s Heart Disease. 2nd ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 24.

Lavigne PM, Karas RH. The current state of niacin in cardiovascular disease prevention: a systematic review and meta-regression. J Am Coll Cardiol. 2013;61(4):440-446. PMID: 23265337 pubmed.ncbi.nlm.nih.gov/23265337/.

Mani P, Rohatgi A. Niacin therapy, HDL cholesterol, and cardiovascular disease: is the HDL hypothesis defunct? Curr Atheroscler Rep. 2015,17(8):43. PMID: 26048725 pubmed.ncbi.nlm.nih.gov/26048725/.

Semenkovich CF, Goldberg IJ. Disorders of lipid metabolism. In: Melmed S, Auchus RJ, Goldfine AB, Koenig RJ, Rosen CJ, eds. Williams Textbook of Endocrinology. 14th ed. Philadelphia, PA: Elsevier; 2020:chap 41.

Last reviewed on: 2/23/2022

Reviewed by: Thomas S. Metkus, MD, Assistant Professor of Medicine and Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A. D.A.M. Editorial team.

Statin and niacin treatment reduces risk of heart attack by 70 percent, can reverse arterial buildup

Archive

November 13, 2000

NEW ORLEANS (Nov. 13) — Treatment with a combination of statin and niacin can slash the risk of hospitalization for chest pain or a heart attack by 70 percent among patients who are likely to suffer heart attacks and/or death from cardiovascular problems, according to a study presented here by researchers at the University of Washington School of Medicine.

The treatment combines two already well-known ways of improving cardiac health: the use of a statin drug to lower levels of the “bad” cholesterol, LDL, and the use of niacin to boost levels of the “good” cholesterol, HDL.

The study found that use of this combined treatment, in people with low levels of good cholesterol and average levels of bad cholesterol, could even remove plaque buildup in the arteries. Cardiovascular disease is the No. 1 killer in the Western Hemisphere.

At the start of the study and again after three years of treatment, doctors performed angiograms of the patients’ arteries. The angiograms showed that in most of the patients who received the combination treatment, plaque buildup had actually decreased.

“This is the first demonstration of a striking clinical benefit from combination drug therapy for a common type of coronary disease patient,” said Dr. B. Greg Brown, a cardiologist and UW professor of medicine.

Researchers are finishing up their analysis of the study data, and plan to submit their report this winter for publication. Brown is the study’s lead author. The results were presented in New Orleans on Nov. 13 at the Scientific Sessions of the American Heart Association.

“This interesting study is a good demonstration of the enormous value of cholesterol management in patients with coronary disease,” said Dr. Claude Lenfant, director of the National Heart, Lung, and Blood Institute, which funded the study.

The same study found that a mixture of antioxidant vitamins had no effect on cardiovascular outcomes. Scientists are not sure why this is so, since there has been laboratory evidence that suggests antioxidants should be helpful.

“More research and larger studies are needed to confirm the lack of effectiveness of antioxidant vitamins on risk for coronary events,” Lenfant said.

Brown was involved in the first studies in the late 1980s that showed that a kind of statin, lovastatin, could reduce the occurrence of major cardiovascular events by about 25 to 35 percent. Giving statins to people with cardiovascular disease is now common.

“What you expect with statins is a slowing of the disease progression, but not a stopping. Arteries continue to get narrower, but not as fast,” Brown said. “But when niacin is combined with a statin, the artery blocking actually improves, on average.”

Brown and colleagues surmised that combining simvastatin with niacin might prevent even more heart attacks and such cardiac events. The goal would be to reduce plaque buildup. That’s important because the cholesterol-rich plaque is what can clog artery walls and lead to fatal complications.

Cholesterol: The statin lowers blood levels of LDL, which is called the “bad” cholesterol because it is more likely to clog ateries. Niacin, or Vitamin B3, is the best agent known to raise blood levels of HDL, which helps dissolve cholesterol deposits from the artery walls.

The 160 patients involved in the study had low levels of good HDL cholesterol (a level of 35 or less). At least four out of every 10 people with coronary artery disease fit this profile. But the study results may have implications for other people with coronary diseases. They would have even higher levels of HDL – and having higher levels of the good cholesterol should only help them, Brown said.

Some patients in this study received simvastatin and niacin, while others received antioxidants. A third group received three treatments while a fourth, control, group received placebos. All patients received exercise training and dietary counseling.

The results for those receiving statin and niacin were startlingly different than the others. The average level of HDL increased from 31 to 38, while the average LDL dropped from 125 to 76 — that is considered an extremely good level of the bad cholesterol. Angiograms showed that most of these people had no additional plaque buildup over the years. In many of them, the amount of plaque actually decreased.

“What we saw was a reversal of the disease,” Brown said. “The patients’ arteries, on average, had stopped narrowing and begun to improve.”

The study involved use of niacin at moderately high and carefully supervised levels. Brown said that people should only take niacin under a doctor’s supervision, because in some patients, the doctor may wish to monitor the patient’s liver. Rarely, the unsupervised use of niacin can cause severe liver problems, including liver failure.

The study had included antioxidants because there has been considerable evidence that they should help protect against the basic mechanisms for cholesterol buildup. The antioxidants involved in this study include Vitamins C, E, beta carotene and selenium.

Others involved in the study include UW researchers Dr. John Albers, Dr. Xue-Qiao Zhao, Dr. Alan Chait, Dr. Lloyd Fisher, Alice Dowdy, Dr. Marian Cheung, Josiah Morse, Leny Serafini and Ellen Huss-Frechette, as well as Debbie DeAngelis and Dr. Jiri Frohlich of the University of British Columbia, Vancouver, B.C.

NOTE: Images relevant to this story may be downloaded from http://depts.washington.edu/hsnews/LAD_regression.html

Is it possible to replace statins with dietary supplements

Atherosclerosis and dyslipidemia

September 17, 2020
ifoucare edition

Often people who are prescribed statins worry about side effects and intolerance, so they want to take dietary supplements instead. But experts believe that natural remedies can only supplement therapy, and not completely replace cholesterol-lowering drugs.

The problem with statins

Almost half of the adults who need to lower their cholesterol do not take any special medications ¹ . This is due to many factors, such as cost, distrust of drugs, and most often fear of possible side effects ^{2, 3} .

Dietary supplements are applied in a complex

BAA are food additives. They contain vitamins, minerals, antioxidants, or other compounds, but are not drugs. Certain foods are known to help lower cholesterol levels. The researchers tested different supplements: red rice, omega-3 fatty acids, spirulina, soy proteins, green tea, lupine, garlic fibers, bergamot and berberine ⁴ , but there is no conclusive evidence of their unequivocal benefit and effectiveness yet.

Natural remedies may be given to patients who cannot tolerate statins, for example due to muscle pain, the most common side effect. Other lipid-lowering drugs, such as ezetimibe and PCSK9 inhibitors, are also an alternative for many. Because treatment options are limited, supplements can help lower cholesterol levels.

It is important to know!

Scientists emphasize that natural remedies cannot completely replace drug therapy with drugs from the statin group – a proven and reliable way to reduce cholesterol levels and the risk of heart disease. Patients should also not substitute any other cholesterol-lowering medications with natural remedies without consulting their doctor. Supplements and dietary changes may only be in addition to the prescribed treatment regimen.

Supplement with garlic extract

Garlic has been used as a traditional medicine for many years. Today, many people use garlic extract supplements as a natural remedy to lower blood pressure and cholesterol levels. Garlic also contains the amino acid cysteine, which produces allicin, a substance that lowers total cholesterol. However, clinical studies have shown conflicting results ⁵ .

Garlic has been shown to regulate triglycerides and total cholesterol, but has no effect on low-density lipoprotein (LDL) and high-density lipoprotein (HDL) ⁶ . This effect was observed only if a person consumed garlic for at least two months. This suggests that the benefit of garlic in lowering cholesterol is short-lived, and after six months, the effect of consumption disappears.

Niacin (Vitamin B3)

It is one of the most effective agents for raising “good” cholesterol levels: it can increase high-density lipoprotein levels by almost 20% ⁷ . Niacin also reduces low-density lipoprotein, or bad cholesterol, by 18% and triglycerides by 36% ⁷ . The effect is dose dependent, usually 1 to 4 grams per day is required ⁷ .

But niacin can cause side effects such as hot flashes, hyperglycemia, increased uric acid levels ⁷ . A hepatotoxic effect is also possible ⁷ . Hot flashes caused by niacin are difficult to tolerate by patients and are a major barrier to the use of this drug ⁷ .

Omega-3 fatty acids and fish oil

Omega-3 fatty acids include alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA). The most studied forms of omega-3 fatty acids are eicosapentaenoic acid and docosahexaenoic acid. They can lower serum triglycerides by up to 50%, but docosahexaenoic acid can raise both “good” and “bad” cholesterol levels ⁸ .

Omega-3s are generally well tolerated. The most common side effects are indigestion, diarrhea and heartburn ⁸ . Many patients complain of a fishy taste in the mouth, especially when taking high doses of supplements. Another effect that omega-3 causes is a decrease in blood clotting. Therefore, patients taking anticoagulants or antiplatelet agents should use omega-3 fatty acids with caution.

red rice

It is obtained by cultivating the yeast Monascus purpureus (red yeast) on white rice. This fermented product contains a group of monacolins, substances that inhibit cholesterol synthesis. Clinical trials have shown a significant reduction in total cholesterol, low density lipoprotein and triglycerides, an increase in high density lipoprotein ⁹ . But the level of the active substance in different samples of rice is not stable enough to speak of an unequivocal positive effect.

Do not self-medicate! Before you start taking any dietary supplement, be sure to consult your doctor!

References

1. Mercado C, DeSimone AK, Odom E, et al. Prevalence of cholesterol treatment eligibility and medication use among adults—United States, 2005-2012. MMWR Morb Mortal Wkly Rep. 2015;64(47):1305-1311. /Mercado C. et al. Prevalence of high cholesterol treatment adherence and medication use among adults—United States, 2005-2012

2. Mozaffarian D, Benjamin EJ, Go AS, et al. Heart disease and stroke statistics—2015 update. circulation. December 17, 2014. http://circ.ahajournals.org/content/early/2014/12/18/CIR.0000000000000152. Accessed January 8, 2017./ Mozaffarian D. et al. Cardiovascular disease and stroke statistics – 2015 update.

3. National Heart, Lung, and Blood Institute. High blood cholesterol: what you need to know. June 2005. www.nhlbi.nih.gov/health/resources/heart/heart-cholesterol-hbc-what-html. /National Heart, Lung and Blood Institute. High Blood Cholesterol: What You Need to Know. June 2005

4. Maciej Banach, Angelo Maria Patti, Rosaria Vincenza Giglio, at all. The Role of Nutraceuticals in Statin Intolerant Patients J Am Coll Cardiol. 2018 Jul, 72 (1) 96-118./M. Banach et al. The role of nutraceuticals in patients with statin intolerance.

9 effects of vitamin B3

Vitamin B3 is an essential nutrient. Every part of our body needs this substance to function properly. There is scientific evidence that this vitamin in supplement form can help lower cholesterol levels, relieve arthritis, improve brain function, and has other benefits. By the way, this vitamin is also called niacin, and sometimes the prefix PP is added instead of B3.

However, if you take large doses of this substance in supplement form, serious side effects may occur. Therefore, it is important to understand that more is not better.

It is one of the eight B vitamins. It has two main chemical forms, each of which affects our body differently. Both forms are found in both foods and supplements.

1. Nicotinic acid: This is a form of niacin that is sold as a supplement. It is used to lower cholesterol levels and the risk of developing cardiovascular disease.
2. Niacinamide or nicotinamide: This chemical form of the vitamin does not lower cholesterol levels. However, it may help treat psoriasis and reduce the risk of non-melanoma skin cancer.

This vitamin is water soluble, which means it is not stored in significant amounts by the body. It also means that our body is able to excrete excess amounts of this vitamin in the urine. Interestingly, a small amount of this nutrient is synthesized from the amino acid tryptophan.

Like all B vitamins, vitamin B3 helps convert food into energy by helping enzymes do their job. This nutrient is the main component of NAD and NADP. These two coenzymes are involved in cellular metabolism.

It also plays a role in cell-to-cell signaling and DNA synthesis. In addition to everything, this vitamin is involved in antioxidant reactions that protect us from the development of diseases and premature aging.

The RDA for this nutrient is 16 mg for adult men and 14 mg for women. During pregnancy and lactation, the norm increases to 18 mg and 17 mg, respectively.

If a person does not get enough of this substance, they may experience the following symptoms: 4

Severe niacin deficiency, or pellagra, is most common in people who do not eat a varied diet. However, in most developed countries, severe deficits are very rare.

Note that deficiency of vitamins and minerals develops with a monotonous diet, as well as with malnutrition. In order to get the concept of a balanced diet, we recommend that you seek the advice of a nutritionist. The specialist will explain the basics of dietology, after which you will be able, both with his help and independently, to create a healthy diet for yourself.

9 effects of vitamin B3 on health0145

This vitamin has been used since the 1950s to lower high cholesterol. In fact, it reduces the level of “bad” cholesterol (low-density lipoprotein, or LDL) by 5-20%. But this vitamin is not the primary treatment for high cholesterol due to its possible side effects. It is mainly used to lower cholesterol levels in people who cannot tolerate statins.

Effect #2 – increase « good cholesterol 0145

In addition to lowering “bad” cholesterol, niacin also increases “good” cholesterol. Studies show that it increases HDL levels by 15-35%.

Effect #3 – Triglyceride Reduction

This vitamin can also reduce triglyceride levels by 20-50%. This is achieved by reducing the activity of an enzyme that is involved in the synthesis of triglycerides. At the same time, the production of both LDL and very low density lipoproteins (VLDL) is reduced. To achieve these effects, therapeutic doses of this vitamin in supplement form are needed.

Effect #4 – reduced risk of developing heart disease

The effect of vitamin PP on cholesterol helps prevent the development of heart disease. In addition, new evidence is emerging about an additional mechanism by which this vitamin benefits the heart. It can reduce oxidative stress and inflammation in the body. Both of these factors are actively involved in the development of atherosclerosis, or hardening of the arteries.

Some studies show that taking this vitamin alone (at therapeutic doses) or in combination with statins can reduce risk in people who already have heart problems. However, the results are still mixed. In a recent scientific review, scientists concluded that niacin does not significantly reduce the risk of heart attack, stroke, or death from heart disease.

Effect #5 – Protecting cells that produce insulin

Type 1 diabetes is an autoimmune disease in which the body attacks and destroys cells that produce insulin. There is research to suggest that this vitamin may protect these cells and possibly even reduce the risk of developing type 1 diabetes in at-risk children.

But for people with type 2 diabetes, things are much more complicated. On the one hand, vitamin B3 supplementation reduces high cholesterol, which is often seen in people with type 2 diabetes. On the other hand, it can increase blood sugar levels. For this reason, people with type 2 diabetes need to be very careful never to self-prescribe supplements.

Effect #6 – improves brain function

Our brain needs this nutrient, which is part of the NAD and NADP coenzymes, to provide the brain with energy and its proper functioning. Confusion in the mind and even psychiatric symptoms can be associated with a deficiency of this vitamin.

Niacin is used to treat some types of schizophrenia. It helps repair brain cell damage resulting from a deficiency of this nutrient. Preliminary research suggests that it may also help maintain brain health in people with Alzheimer’s disease. However, the results are mixed.

Skin Health Benefit #7

This vitamin helps protect skin cells from sun damage. Moreover, he does this both in the form of tablets (capsules) and in the form of a lotion. Recent studies have shown that this vitamin can help prevent certain types of skin cancer. One study showed that taking nicotinamide 500 mg twice daily reduced the incidence of non-melanoma skin cancer in people at risk.

Effect #8 – Alleviate Arthritis Symptoms

In one preliminary study, this vitamin helped relieve some of the symptoms of osteoarthritis. The participants of the experiment improved joint mobility and decreased the need for non-steroidal anti-inflammatory drugs (NSAIDs). Another study in rats found that an injection of this vitamin reduced the inflammation associated with arthritis. While the data are promising, more research is needed to confirm all of these effects.

Effect #9 – treats pellagra

Severe vitamin B3 deficiency causes a condition called pellagra. People with this disorder develop problems with the skin, gastrointestinal tract, and nervous system. Taking this vitamin in supplement form is the primary treatment for pellagra.

As already mentioned, severe deficiency of this nutrient is extremely rare. But with alcoholism, anorexia, or Hartnup’s disease, the risk of its severe deficiency increases.

Niacin in foods

This vitamin is found in both animal and plant foods. Interestingly, some energy drinks also contain B vitamins, sometimes in very high doses. But that’s just a fun fact to be aware of. In no case do not get carried away with these drinks!

Main food sources:

• Lean beef, chicken, turkey, liver, eggs,
• Salmon, mackerel
• Lentils, beans, green peas, avocados
• Peanuts, pumpkin seeds
• Brown rice, potatoes
• Milk and cheeses 03 Boiled coffee.