Niacin (aka nicotinic acid) is another name for vitamin B3. In high dosages of 3-4 g per day, niacin very effectively increases HDL levels by up to 35%.[13] In this regard, niacin strikingly outperforms statins, which raise HDL by only around 5%.[11] A recent study compared head-to-head the HDL elevating efficacy of low dose niacin (750-1500 mg/day) with statin and fibrate (two commonly used lipid medications).


200 patients with low HDL levels were randomly assigned for treatment either with: 

First 6 weeks

atorvastatin 10 mg/day

fenofibrate 160 mg/day

niacin-extended release (ER) 750 mg/day 

Final 6 weeks

atorvastatin 20 mg/day

fenofibrate 320 mg/day

niacin-extended release (ER) 1,500 mg/day

After 6 weeks of treatment, the dosages of the medications were doubled and the patients were finally assessed after 12 weeks for their lipid values. 


Niacin therapy 750 mg and 1.5 g/day resulted in a significant rise in HDL by 8.1% and 12.4% respectively. 

Fenofibrate 160 and 320 mg/day also resulted in a significant rise in HDL by 3.8% and 6.2%, respectively. 

However, atorvastatin 10 and 20 mg/day did not significantly impact HDL levels. 

By increasing HDL, niacin was found to be most effective in reduction of 10-year heart disease risk percentage, followed by fenofibrate, while atorvastatin had no effect.


This study shows that a moderately high dose of niacin (vitamin B3) is more effective in elevating protective HLD levels than popular cardiovascular disease medications. By increasing HDL levels, niacin is a safe and effective way to reduce the cumulative heart disease risk among people with low HDL levels. Niacin also beneficially impacts a number of other important heart disease risk factors (which will be covered in upcoming articles).[14]

The take home message is that high dose vitamin therapies, which are safe, can be far more effective than medications which often come with serious side effects. Decades of clinical data have confirmed the overall safety of niacin therapy.[15, 16] A review of the U.S. Food and Drug Administration (FDA) Adverse Event Reporting System found niacin (in the form of nicotinic acid) to be associated with a lower rate of serious adverse events (defined as resulting in hospitalization or death), liver toxicity, and muscle destruction (rhabdomyolysis) compared with that of several other commonly used lipid-altering drugs including simvastatin, pravastatin, atorvastatin, gemfibrozil, and fenofibrate.[16]

It is notable that niacin is the only available agent that significantly reduces levels of Lp(a) [Lipoprotein(a)][17-19], an established heart disease risk factor.[20-24] Statins either don't impact Lp(a) levels [25, 26] or actually increase Lp(a) levels.[27] Thus, it is possible that Lp(a) contributes to the residual risk seen after statin treatments.[28] Support for this comes from the finding that Lp(a) is not correlated with other well-recognized risk factors for early heart attack (myocardial infarction), such as LDL and old age, and is under separate metabolic control than other cardiovascular risk factors (like apolipoprotein B).[29]

SIDE NOTE          

Elevated Lp(a) levels constitute an independent risk factor for early heart attack even in young adults under 45 years of age.[29] Therefore, niacin holds tremendous potential as a primary prevention supplement/medication for the younger generation in order to prevent development of future heart disease. More in this in upcoming posts...


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