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July 2014

Niacin Might Cause Harmful Side Effects

Contrary to previous findings, a new study suggests that niacin does not benefit heart health, and might increase the risk for serious side effects.

Niacin has been a commonly-accepted treatment for high cholesterol. Previous research shows that niacin (not niacinamide) has benefits on levels of high-density cholesterol (HDL or "good cholesterol"), with better results than drugs such as "statins" like atorvastatin (Lipitor®). There are also benefits on levels of low-density cholesterol (LDL or "bad cholesterol"), although these effects are less dramatic. Adding niacin to a second drug such as a statin might increase the effects on low-density lipoproteins.

In a new study, researchers randomly assigned 25,673 adults with heart disease to receive 2 grams of extended-release niacin and 40 milligrams of laropiprant, which is commonly used in combination with niacin, or placebo. All participants were also being treated with a statin medication. Major heart disease-related events, such as heart attack, death or stoke, were the main outcome measure of the study.

Throughout the average 3.9 year follow-up period, people who were given the niacin treatment had LDL levels that were an average of 10 milligrams per deciliter of blood lower, and HDL levels that were an average of 6 milligrams per deciliter of blood higher than those in the placebo group. However, people treated with niacin did not have any decreased risk for a heart disease-related event. Niacin significantly increased the risk for problems with blood sugar control in people with diabetes, and also increased the risk for a diabetes diagnosis. Furthermore, niacin use was linked to an increase in many different serious side effects, including gastrointestinal, musculoskeletal, bleeding, infection and skin-related adverse effects.

The authors concluded that while niacin increased HDL and decreased LDL, it had no effect on the risk for heart disease-related events, and increased the risk for serious side effects.

For information about niacin, please visit Natural Standard’s Food, Herbs & Supplements Database.


  1. HPS2-THRIVE Collaborative Group, Landray MJ, Haynes R, et al. Effects of extended-release niacin with laropiprant in high-risk patients. N Engl J Med. 2014 Jul 17;371(3):203-12.
  2. Natural Standard: The Authority on Integrative Medicine. 

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