Niacin (B3)
Nicotinic acid / nicotinamide / vitamin B3 · Metabolic
Moves lipid numbers convincingly and failed to move outcomes — the clearest surrogate-endpoint lesson in this catalog.
What the evidence says
Pharmacological niacin raises HDL and lowers triglycerides substantially — the numbers look excellent. Then AIM-HIGH and HMSTC/HPS2-THRIVE tested whether that translated into fewer cardiovascular events on top of statins, and it did not; HPS2-THRIVE found excess serious adverse events. Nicotinamide is a separate form used in dermatology that does not cause flushing or move lipids.
What studies used
Requirements sit near 14–16 mg/day; the lipid trials used gram-scale prescription doses. Published studies had not established a preferred timing.
Reported from published studies and product labelling — a record of what was used in research, not a recommendation. What is right for you is a conversation with a clinician.
Watch out for
- The flush is harmless but intense; sustained-release forms marketed to avoid it carry greater hepatotoxicity risk
- Gram-scale niacin can raise blood glucose, uric acid and liver enzymes — this is prescription territory, not a supplement decision
Evidence base
established literature
Large human evidence base: several phase 3 or 4 trial reports, plus multiple meta-analyses or systematic reviews.
This letter measures how much human research exists, not whether it works for you — the tier above (Moderate) is the read on quality.
Research (12)
- Dyslipidaemia in nephrotic syndrome: mechanisms and treatmentNat Rev Nephrol · 2018
- Comparative effects of vitamin and mineral supplements in the management of type 2 diabetes in primary care: A systematic review and network meta-analysis of randomized controlled trialsPharmacol Res · 2023
- Extended-release niacin (nicotinic acid)/laropiprantDrugs · 2009
- Mechanism of action of niacinAm J Cardiol · 2008
- Hyperlipidaemia and cardiovascular disease: low HDL-cholesterol as a therapeutic target in statin-treated patients: a role for nicotinic acid (niacin)?Curr Opin Lipidol · 2010
- Niacin and laropiprantDrugs Today (Barc) · 2010
- [Niacin in therapy]Postepy Hig Med Dosw (Online) · 2007
- Cholesterol efflux potential and antiinflammatory properties of high-density lipoprotein after treatment with niacin or anacetrapibArterioscler Thromb Vasc Biol · 2010
- Meta-analysis of the effect of nicotinic acid alone or in combination on cardiovascular events and atherosclerosisAtherosclerosis · 2010
- Simvastatin and niacin, antioxidant vitamins, or the combination for the prevention of coronary diseaseN Engl J Med · 2001
- Advancing therapy for hypercholesterolemiaExpert Opin Pharmacother · 2010
- Fibrates and niacin: is there a place for them in clinical practice?Expert Opin Pharmacother · 2014
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