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Niacin

The dreaded niacin “flush” | Track Your Plaque Blog - trackyourplaque.com, 5/18/07 - "a very simple maneuver can relieve the hot flush in over 90% of instances: Drink water. Let me explain ..."

Note:  I see a lot of orders for no-flush niacin.  I assume the reason people are buying this is to raise HDL cholesterol.  I couldn't find any research that no-flush niacin works to increase HDL.  It's probably a waste of money for the no-flush.  Just do a Medline search of  hexanicotinate HDL, hexaniacinate HDL or no-flush niacin.  Here are the the only studies I could find:

Accumulation of chylomicron remnants and impaired vascular reactivity occur in subjects with isolated low HDL cholesterol: effects of niacin treatment - Atherosclerosis. 2006 Jul;187(1):116-22 - "evaluation of no-flush niacin treatment ... Twenty-two low HDL subjects with reduced FMD were randomized into two groups, one given 1.5 g/day niacin and a placebo group. After 3-month treatment, plasma lipids and chylomicron kinetics were not changed by niacin treatment"

Varying cost and free nicotinic acid content in over-the-counter niacin preparations for dyslipidemia - Ann Intern Med. 2003 Dec 16;139(12):996-1002 - "Commonly used over-the-counter niacin preparations (500-mg tablets or capsules) from the 3 categories of immediate-release, sustained-release, and no-flush were purchased at health food stores and pharmacies and from Internet-based vitamin companies ... The average content of free nicotinic acid was 520.4 mg for immediate-release niacin, 502.6 mg for sustained-release niacin, and 0 for no-flush niacin ... No-flush preparations of over-the-counter niacin contain no free nicotinic acid and should not be used to treat dyslipidemia. Over-the-counter sustained-release niacin contains free nicotinic acid, but some brands are hepatotoxic. Immediate-release niacin contains free nicotinic acid and is the least expensive form of over-the-counter niacin"

http://www.lipidsonline.org/slides/slide01.cfm?tk=25&dpg=34 shows that with extended release niacin, HDL peaks out at 2,500 mg.  http://www.lipidsonline.org/slides/slide01.cfm?q=effect+of+niacin&dpg=7 hows immediate release crystalline niacin compared to Niaspan.  There isn't much gain in HDL with the immediate release crystalline niacin after 1,000 mg per day.  After seeing that, I'll probably cut down from 3,000 mg but from the slide it appears that there is a significant advantage to lowering triglycerides by going to 3,000 mg plus there is a linear decrease in LDL-C by going to 3,000 mg immediate release crystalline niacin.  This graph also shows that immediate release crystalline niacin is significantly better at raising HDL and lowering triglycerides compared to Niaspan.  Also see the slide titled CHD Risk According to HDL-C Levels.

I’ve never seen any studies on Niaspan and liver damage but it would seem like it would be similar to the slow release niacin. The only study I’ve seen on that is:

A comparison of the efficacy and toxic effects of sustained- vs immediate-release niacin in hypercholesterolemic patients - JAMA. 1994 Mar 2;271(9):672-7 - "None of the patients taking IR niacin developed hepatotoxic effects, while 12 (52%) of the 23 patients taking SR niacin did"

Be sure to see a doctor to have your liver enzymes checked before and after taking any niacin supplement.  See the bottom of http://www.lipidsonline.org/slides/ for some great slide shows on HDL.  The January 2007 Harvard Men's Health Newsletter has a good article on HDL cholesterol but it is a paid subscription.  See niacin at Amazon.com.

Related Topics:

• HDL Cholesterol

Specific Recommendations:

• Niacin at Amazon.com

Related products that also may increase HDL:

• inositol hexanicotinate-no-flush niacin / policosanol / red clover extract / red yeast rice / hesperidin

General Information:

• Extended-Release Niacin and Hyperlipidemia Management - November 15, 2000 - American Academy of Family Physicians - aafp.org - "Niacin can lower LDL cholesterol by 10 to 25 percent and triglyceride levels by 20 to 50 percent, and can raise levels of high density lipoprotein (HDL) cholesterol by 15 to 35 percent ... The daily niacin dosage was started at 375 mg taken nightly and slowly increased, to a maximum of 3,000 mg per day, at four-week intervals for a total of 25 weeks. Patients were permitted to take 325 mg of aspirin before taking the study medication if they wished to prevent flushing ... The dose response demonstrates a linear effect, with maximal benefit at a dosage of approximately 2,500 mg, although the maximum recommended dosage of extended-release niacin is 2,000 mg"
• Niacin - A New Look at an Old Drug - U.S. Pharmacist, 10/15/03 - "In one study, up to 53% of patients treated with IR niacin reported flushing, compared with 22% in the SR niacin group; four of the 23 IR-treated patients (17%) withdrew because of flushing. However, 67% of patients discontinued SR niacin therapy because of liver enzyme elevations (three times the upper limit of normal), and 52% of patients developed hepatotoxic symptoms; however, no patients treated with IR niacin developed significant changes in liver enzymes ... Because the incidence and severity of flushing often decreases with continued use—sometimes dissipating altogether—stress that any interruptions in therapy may lead to losing any tolerance" - Note:  I've been taking two grams of the TwinLab immediate release niacin for years and I don't get any flush from it if I take it with a little food. - Ben
• A comparison of the efficacy and toxic effects of sustained- vs immediate-release niacin in hypercholesterolemic patients - JAMA. 1994 Mar 2;271(9):672-7 - "None of the patients taking IR niacin developed hepatotoxic effects, while 12 (52%) of the 23 patients taking SR niacin did"

News & Research:

• Researchers discover intake of FDA-approved drug modulates disease progression in Alzheimer’s disease mode - Science Daily, 3/23/22 - "Niacin, which sustains metabolism throughout the body, is mainly obtained through a typical diet; it also can be taken in supplements and cholesterol-lowering drugs ... After the Alzheimer's disease animal models received niacin, they ended up with fewer plaques and they have improved cognition ... Past epidemiology studies of niacin and Alzheimer's disease showed that people who had higher levels of niacin in their diet had diminished risk of the disease ... Niacin is also currently being used in clinical trials in Parkinson's disease and glioblastoma" - See niacin at Amazon.com.
• Lipid-Modifying Agents to Treat or Prevent COVID-19? - Medscape, 10/26/21 - "statins inhibit 3-hydroxy-3-methyl-glutaryl-coenzyme A reductase and the production of isoprenoid intermediates, which are "critical for viral entry, immune signaling, and the inflammatory cascade." They induce transcription factors that limit inflammation and prothrombotic functions of activated endothelial cells ... statins have antioxidant and antiapoptotic effects, potentiate nitric oxide production, and upregulate transforming growth factor beta receptor III, leading to less collagen deposition and pulmonary fibrosis ... Omega-3 polyunsaturated fatty acids "act as a precursor to lipid mediators that reduce inflammation" and may therefore be beneficial in addressing the COVID-19 inflammatory response ... Niacin increases HDL cholesterol levels, may reduce inflammatory mediators, and may also possess antiviral activity"
• Vitamin B3 revitalizes energy metabolism in muscle disease - Science Daily, 5/14/20 - "Vitamin B3 forms have recently emerged as potent boosters of energy metabolism in rodents. These vitamins are precursors for NAD+, a molecular switch of metabolism between fasting and growth modes ... niacin treatment efficiently increased blood NAD+ both in patients and healthy subjects. Niacin restored NAD+ in the muscle of the patients to the normal level and improved strength of large muscles and mitochondrial oxidative capacity. Overall metabolism shifted towards that of normal subjects ... The study is a significant leap in the development of targeted therapy options for energy metabolic diseases"
• Vitamin B Derivative (Nicotinamide) Appears to Reduce Skin Cancer Risk - Medscape, 10/16/17 - "Nicotinamide is a widely available, inexpensive and welltolerated agent. It has been reported in a small number of studies to be of benefit in a range of skin conditions, including acne, rosacea, immunobullous disease and photoaging. Recent studies show that it may also be an effective chemopreventive agent against skin cancer, possibly due to its ability to both augment cellular DNA-repair mechanisms and counteract UVinduced immunosuppression. Due to its favorable safety profile and demonstrated effectiveness, nicotinamide supplementation should be considered as an adjunctive chemopreventative treatment for patients at high risk of developing NMSC or AKs." - See nicotinamide at Amazon.com.
• People with forms of early-onset Parkinson's disease may benefit from boosting niacin in diet, research suggests - Science Daily, 1/10/17 - "With this extra source of NAD, the flies had far fewer faulty mitochondria than their mutant peers on a regular diet ... The vitamin also prevented the flies from losing neurons ... The results suggest that in familial Parkinson's, available NAD is critical for keeping mitochondria in shape and the disease at bay. Drugs that block NAD-consuming DNA repair already exist to treat cancer. Loading up on niacin probably can't hurt either ... This study strengthens the therapeutic potential for Vitamin B3/niacin-based dietary interventions and PARP inhibition in the treatment of Parkinson's disease"
• Study found high-risk patients who took nicotinamide daily developed fewer non-melanoma lesions - WebMD, 10/21/15 - "A form of vitamin B3 called nicotinamide appears to reduce non-melanoma skin cancers by 23 percent when taken twice daily ... The vitamin supplement also appeared to reduce the numbers of thick, scaly patches of skin that can become cancer. Those patches were reduced in the nicotinamide group by 11 percent at three months, and by 20 percent at nine months of treatment"
• Surprising Result Shows Kidney, Mortality Benefits of Niacin - Medscape, 11/21/14 - "The proportion of patients experiencing a rapid decline in estimated glomerular filtration rate (eGFR) can be decreased significantly with niacin, as can all-cause mortality ... patients who took niacin had an 11% decreased risk of death ... Niacin has been shown to decrease reactive oxygen species, inflammation, hypertriglyceridemia, hyperphosphatemia, and endothelial dysfunction — all factors associated with a decline in eGFR" - See niacin at Amazon.com.
• Niacin Doesn't Reduce Heart Problems, May Create Some, Research Finds - WebMD, 7/16/14 - "Half the patients received treatment with an extended-release pill containing niacin and laropiprant, while the other half received an inactive placebo. Laropiprant is a medication that treats flushed skin, which is a common side effect of niacin" - Note:  This has gone back and forth for years.  I'm still going to take my  1000 mg of immediate release niacin per day not only for the increased HDL but for a healthy skin.  For one thing, I don't see how they can reach that conclusion by saying that an extended-release pill containing niacin and laropiprant is the same as taking immediate release niacin along.  For one thing, see:
  • A comparison of the efficacy and toxic effects of sustained- vs immediate-release niacin in hypercholesterolemic patients - JAMA. 1994 Mar 2;271(9):672-7 - "None of the patients taking IR niacin developed hepatotoxic effects, while 12 (52%) of the 23 patients taking SR niacin did"
• Mouse study offers new clues to cognitive decline - Science Daily, 5/8/14 - "The pathway begins with the B vitamin nicotinamide. Cells take dietary nicotinamide and, with a helper protein called Nampt, manufacture a molecule called NMN, which then is processed further to make NAD. When Stein eliminated Nampt from neural stem cells, several significant changes took place ... Levels of NAD dropped, and the neural stem cells stopped dividing; they stopped renewing themselves; and they stopped being able to create important cells that insulate axons, the "wires" that carry electrical signals throughout the brain. With less insulation, these signals slow down, impairing brain function"
• Energizing sick mitochondria with vitamin B3: Effective treatment for mitochondrial disease - Science Daily, 4/7/14 - "Vitamins B have recently been turned out to be potent modifiers of energy metabolism, especially the function of mitochondria. Vitamin B3, (niacin) has been found to delay the signs of aging in animal models ... Mitochondria power up all cells in our bodies, by generating fuel, ATP, for all cellular functions ... feeding mice with food supplemented with B3 form, nicotinamide riboside, delayed their mitochondrial myopathy" - Note: It seems like you could kill two birds with one stone by taking niacin to raise the good cholesterol.
  • What Is the Difference Between Niacin & Niacinamide? - LiveStrong.com - "Your body can convert niacin into niacinamide ... Niacin and niacinamide have identical function when used as vitamins ... their pharmacologic properties differ. For example, high doses of niacin can cause skin flushing. Niacinamide, however, does not have the same vasodialating, or blood-vessel widening, effects, that niacin has, so it does not lead to skin flushing" - Note:  You'll find contradictory information on the Internet but niacinamide will not raise HDL and niacin will.  See niacin at Amazon.com.
• 'Good' cholesterol controls blood glucose - Science Daily, 10/30/13 - "without ApoA-I, burning of calories is reduced in skeletal muscle resulting in increased blood glucose and weaker muscle function. The scientists then determined that HDL cholesterol and its protein ApoA-I both enhance usage of glucose and calories inside muscle cells. Raising HDL and ApoA-I levels in animal models resulted in protection against hyperglycemia and age-related symptoms such as decline of muscle performance or fat mass gain. Improved calorie burning in mitochondria (the "power plants" in each cell) was further indicated by a marked reduction of circulating Fibroblast Growth Factor 21, a novel biomarker for mitochondrial dysfunction ... Our results link for the first time low HDL-cholesterol with impaired use of glucose and burning of calories in type 2 diabetes" - See niacin at Amazon.com.
• Niacin, the fountain of youth - Science Daily, 9/30/13 - "Vitamin B3 -- also known as niacin -- and its metabolite nicotinamide in the worms' diet caused them to live for about one tenth longer than usual" - See niacin at Amazon.com.
• New research shows that while niacin added to statin therapy increases HDL cholesterol levels it does not improve HDL functionality - Science Daily, 3/10/13 - "While two large clinical trials recently showed that adding niacin to statin therapy failed to improve clinical outcomes despite a significant increase in HDL-C levels, little is known about exactly why the increased HDL-C levels did not reduce the risk of cardiovascular events ... We performed a small trial to examine how niacin modulated a classic function of HDL, namely its ability to promote cholesterol removal from cells ... As expected, they saw a 29 percent increase in HDL cholesterol with the addition of niacin to statin therapy, compared to a two percent increase in those treated with statin only. However, on the measures of cholesterol efflux capacity and the HDL inflammatory index, they saw no significant changes in HDL function"
• Raising HDL Levels May Not Lower Heart Attack Risk - WebMD, 5/16/12 - "Many clinicians still prescribe the vitamin niacin to help raise HDL levels, even though a government-funded trial proved disappointing ... The trial was halted early a year ago when it was determined that people with heart disease who had low HDL levels did not benefit from the treatment ... The drug company Pfizer abandoned its experimental HDL-boosting drug torcetrapib in 2006 when trials showed an increase in heart attack and stroke risk among users ... the new research casts even more doubt on the strategy of raising HDL to lower heart and stroke risk ... HDL levels are related to risk, but that doesn't mean that raising HDL is beneficial ... What we do know is that lowering LDL has a big impact on risk, so the take-home message remains, 'Get those LDL numbers down'"
• Niacin doesn't stop heart attacks, major study finds - Health - Heart health - msnbc.com - MSNBC, 5/26/11 - "The newest study tested Abbott Laboratories' Niaspan, an extended-release form of niacin that is a far higher dose than is found in dietary supplements ... the Niaspan users saw their HDL levels rise, and their levels of risky triglycerides drop, more than people who took a statin alone. But the combination treatment didn't reduce heart attacks, strokes or the need for artery-clearing procedures such as angioplasty ... That finding "is unexpected and a striking contrast to the results of previous trials," ... Also, there was a small increase in strokes in the high-dose niacin users — 28 among those 1,718 people given Niaspan compared with 12 among the 1,696 placebo users. The NIH said it was not clear if that small difference was merely a coincidence, as previous studies have shown no stroke risk from niacin. In fact, some of the strokes occurred after the Niaspan users quit taking that drug" - See my niacin and HDL pages for many more studies.  For one thing, there are waaaay more arguments for raising HDL than just heart disease.  Things such as centurions having unusually high HDL, prostate cancer, bowel cancer, impotence, Alzheimer's, etc., not to mention that it conflicts with other studies.
• Evolving Concepts of the Role of High-Density Lipoprotein in Protection from Atherosclerosis - Curr Atheroscler Rep. 2011 Mar - "HDL is able to interact with and remove cholesterol from the lipid-laden foam cells in the peripheral vasculature with subsequent transportation to the liver for excretion. However, HDL has multiple other physiologic effects that may play a significant role in protection from atherosclerosis. HDL has been demonstrated to exhibit multiple beneficial effects on the coagulation system. Platelet function is improved by both direct and indirect mechanisms. HDL has a complex interaction with the protein C and protein S system. Thrombolytic balance is also improved by HDL. HDL has been demonstrated to have a significant natural antioxidant effect that inhibits the oxidative step required for low-density lipoprotein uptake by the macrophage. Additionally, HDL has also been demonstrated to exert multiple beneficial effects on endothelial function, including decreased apoptosis and endothelial repair" - See niacin at Amazon.com (niacin increases HDL).
• Preventing heart problems while keeping a cool head: Cause of flushing effect arising from cholesterol treatment with nicotinic acid - Science Daily, 7/26/10 - "The opposite approach, which involves increasing the concentration of "good" HDL cholesterol using nicotinic acid, has proven unpopular among patients up to now. The reason for this is that treatment with nicotinic acid has an unpleasant but harmless side-effect: the drug makes patients turn quite red in the face ... the higher an individual's level of HDL cholesterol, the lower his or her risk of contracting these diseases. For this reason, the strategy of increasing HDL plasma concentration through medication has become more prevalent of late. The drug on which most hopes are pinned here is nicotinic acid ... The flushing phenomenon can be prevented by inhibiting prostaglandin formation or blocking the prostaglandin receptors in the skin, while the desired effects of the nicotinic acid on lipid metabolism remain unaffected"
• Vitamin B3 shows early promise in treatment of stroke - Science Daily, 2/24/10 - "An early study suggests that vitamin B3 or niacin, a common water-soluble vitamin, may help improve neurological function after stroke ... Niacin is known to be the most effective medicine in current clinical use for increasing high-density lipoprotein cholesterol (HDL-C), which helps those fatty deposits ... Niacin essentially re-wires the brain which has very exciting potential for use in humans"
• Quality of HDL Differs in Diabetics But Improves With Niacin Therapy - Medscape, 12/22/09 - "HDL cholesterol in individuals with diabetes has impaired endothelial protective functions compared with the HDL from healthy subjects, although treatment with extended-release niacin can improve these endothelial protective effects"
• Adding Niacin Boosts Effectiveness of Simvastatin/ezetimibe - Medscape, 12/16/09 - "In high-risk patients with hyperlipidemia, the addition of extended-release niacin provides superior results to therapy with simvastatin and ezetimibe alone ... At 64 weeks, compared with simvastatin and ezetimibe alone, the triple combination significantly improved HDL cholesterol (+21.5%), triglycerides (-17.6%), non-HDL cholesterol (-7.3%), low-density lipoprotein cholesterol, apolipoprotein B and A-I, and lipoprotein ratios"

• Vitamin B niacin offers no extra benefit to statin therapy in seniors already diagnosed with coronary artery disease, study suggests - Science Daily, 11/18/09 - "This does not mean that niacin therapy may not have other cardiovascular benefits, but any such benefits are independent of reducing the amount of plaque buildup and patients should be aware of that ... Lima cautions that an ongoing national study of the long-term vascular benefits of dual therapy and whether extended-release niacin, also known as nicotinic acid, lowers death rates from heart disease should provide more definitive data" - Note:  The article implies that prescription Niaspan works better than immediate release niacin.  See http://www.lipidsonline.org/slides/slide01.cfm?q=effect+of+niacin&dpg=7 which implies the opposite.  The prescription might have less flush but I couldn't tell the difference.  Like I've said in the past, the flush gets less the longer you use it and is practically non-existent after you taken it for several months if you take it with food.  Also, the slow release may produce liver damages.  See:

  • A comparison of the efficacy and toxic effects of sustained- vs immediate-release niacin in hypercholesterolemic patients - JAMA. 1994 Mar 2;271(9):672-7 - "None of the patients taking IR niacin developed hepatotoxic effects, while 12 (52%) of the 23 patients taking SR niacin did"
• Niacin Tops Zetia in Cutting Artery Plaque - WebMD, 11/16/09 - "The question is whether ezetimibe works at all ... Niacin has been around for 50 years. It's a well-understood drug, and in this trial it was clearly superior ... Ultrasound images of neck arteries showed that Niaspan reduced artery plaque by about 2%. Zetia did not slow plaque buildup, although it did lower cholesterol"
• ARBITER 6-HALTS: HDL Raising With Niacin Superior to Ezetimibe - Medscape, 11/16/09 - "Adding extended-release niacin (Niaspan, Abbott) to statin therapy results in a significant regression of atherosclerosis as measured by carotid intima-media thickness (IMT), whereas the addition of ezetimibe (Zetia, Merck/Schering-Plough) to statin therapy did not, according to an eagerly anticipated study"
• Raising 'Good' Cholesterol Levels May Benefit Clogged Arteries - Science Daily, 11/6/09 - "Using MRI scans, we have shown a reduction in the size of artery walls in patients after a year of treatment with nicotinic acid ... Nicotinic acid, sometimes known as niacin, is one of the oldest drugs used for atherosclerosis and only fell out of favour as statins came to prominence. It is known to raise levels of good cholesterol in the blood"
• MRI study: Reduced carotid wall area with Niaspan - theheart.org, 10/30/09 - "So, in terms of relieving a stenosis, for example, it is not clinically relevant. The point is the direction of change. Atherosclerosis has, for years, been considered a relentlessly progressive disease process. To bring about a demonstrable reversal, however small, in only 12 months is mechanistically significant," he said. "Furthermore, remember that the plaque is heterogeneous. We don't know what compositional changes have been induced, but if, for example, the lipid component had been reduced—and there are data from other studies to suggest this happens—then even a small change in total size could be very relevant to plaque behavior."
• Ignored cholesterol blamed for heart attacks - MSNBC, 6/9/09 - "Statins — taken by millions to cut heart attack and stroke risk — do not affect lipoprotein (a) ... people with the highest liporotein (a) levels were two to three times more likely to have a heart attack than those with the lowest levels ... Niacin, a vitamin often prescribed generically to lower cholesterol, also lowers lipoprotein (a) levels. It can cause uncomfortable flushing, however. Aspirin can also lower lipoprotein (a) levels" - [WebMD]
• Biology Of Flushing Could Renew Niacin As Cholesterol Drug - Science Daily, 4/6/09 - "Niacin, also known as nicotinic acid or vitamin B3, has long been regarded as one of the most effective weapons in managing cholesterol. It can lower levels of triglycerides, fatty acids and to a lesser extent, the "bad" kind of cholesterol (LDL) while at the same time powerfully increasing the "good" kind (HDL). But there's a catch – a big one. Patients don't like to take niacin because in most of them, it causes embarrassing, uncontrollable intense flushing, a rush of blood to the face and other skin surfaces accompanied by a prickling sensation ... One particular protein in that group, beta-arrestin1, was found to trigger the chemical reaction that led to flushing ... beta-arrestin1 plays no role whatsoever in niacin's ability to lower cholesterol and fatty acids ... the discovery opens the door to the possibility of developing a "biased ligand," a drug that would trigger GP109A, but not the beta-arrestins"
• Low Levels Of Good Cholesterol Linked To Memory Loss, Dementia Risk - Science Daily, 6/30/08 - "Researchers defined low HDL as less than 40 mg/dL ... At age 60, participants with low HDL had a 53 percent increased risk of memory loss compared to the high HDL group" - [WebMD] - The best way to increase HDL is niacin.  See niacin at Amazon.com.  Start slow maybe even with the 100 mg capsules.  It took me about three months to get immune to the flush from 2000 mg per day.  Taking it with soup seems to be the best.
• Niacin's Role In Maintaining Good Cholesterol - Science Daily, 6/5/08
• Combination Niacin-Laropiprant Plus Simvastatin Reduces Cholesterol by Almost 50% - Doctor's Guide, 11/6/07 - "When patients with dyslipidemia added simvastatin to their experimental combination of extended-release niacin and laropiprant -- a novel anti-flushing agent -- they reported reductions in low density lipoprotein cholesterol (LDL-C) of as much as 48% from baseline ... high density liopoprotein cholesterol (HDL-C) was increased by 28% and triglycerides decreased by 33%"
• New Combination Drug Improves Multiple Cholesterol Disorders in Single Pill - Doctor's Guide, 11/5/07 - "Simcor combines prescription niacin and simvastatin, two FDA-approved medications with established safety profiles, to target good cholesterol (HDL), bad cholesterol (LDL), and triglycerides in a single pill" - Sounds stupid to me.  Why would you pay prescription drug prices for something that is dirt cheap like niacin.  It is the Niaspan form of niacin, which they claim has less flush.  I tried Niaspan and couldn't tell any difference in the flush plus the flush eventually stopped even with immediate release niacin.  Plus I worry about increased liver damage with Niaspan.  Click here for the study that concerns me which was sustained release niacin, not Niaspan but it would seem to be similar.  Plus immediate release niacin is about 20% more effective at raising HDL than Niaspan.  Click here and note where Niaspan is on the graph.  I'm just eye balling the 20%.
• Merck Niacin Drug Controls Cholesterol - Intelihealth, 9/5/07 - "The drug, called Cordaptive, can both raise good cholesterol and lower bad cholesterol. It combines an extended-release form of the B vitamin niacin with a chemical to inhibit an often intolerable niacin side effect called flushing -- redness, burning and tingling of the face ... compared with dummy pills, Cordaptive produced an 18 percent drop in levels of LDL-C, or "bad" cholesterol; a 26 percent drop in another type of blood fat called triglycerides, and a 20 percent increase in levels of HDL-C, or "good" cholesterol"
• Niacin (Nicotinic Acid) -- The Old Drug Is Making a Comeback With A New Act - Medscape, 6/11/07 - "Niacin (nicotinic acid) is well known as the most effective drug currently available for raising levels of high-density lipoprotein (HDL) cholesterol, raising it by 25% to 35% at the highest doses"
• FDA Approvals: Veramyst, Niaspan, and HepaGam B - Medscape, 5/9/07 - "Film-Coated Niacin Extended-Release Caplets (Niaspan) May Reduce Flushing ... use of the new orange-coated formulation significantly reduced the incidence of flushing by 9%"
• Combining Agents Leads to Safe Treatment of Lipid Abnormalities - Physician's Weekly, 5/7/07 - "Combining the use of statins and niacin should be encouraged because it appears to safely treat multiple lipid abnormalities in appropriate high-risk patients"
• Improving Outcomes With HDL Cholesterol - Physician's Weekly, 4/9/07 - "Patients who have high HDL levels appear to have better protection against vascular disease than others and some variants of HDL may actually reduce plaque in the coronary arteries. Essentially, HDL acts as a scavenger compound; it moves the lipids from the blood vessel to the liver, where they are then excreted from the body ... Currently, in the United States, the only medication other than statins designed specifically to help physicians raise the HDL cholesterol levels in their patients is niacin"
• An Old Cholesterol Remedy Is New Again - New York Times, 1/23/07 - "In its therapeutic form, nicotinic acid, niacin can increase HDL as much as 35 percent when taken in high doses, usually about 2,000 milligrams per day. It also lowers LDL, though not as sharply as statins do, and it has been shown to reduce serum levels of artery-clogging triglycerides as much as 50 percent ... There’s a great unfilled need for something that raises HDL ... Right now, in the wake of the failure of torcetrapib, niacin is really it. Nothing else available is that effective" - See niacin at Amazon.com.
• Gene Tied To Longevity Also Preserves Ability To Think Clearly - Science Daily, 12/26/06 - "Centenarians were three times likelier to possess CETP VV compared with a control group representative of the general population and also had significantly larger HDL and LDL lipoproteins than people in the control group ... Researchers believe that larger cholesterol particles are less likely to lodge themselves in blood vessels" - Could niacin do the same thing?  See:
  • Effects of extended-release niacin on lipoprotein particle size, distribution, and inflammatory markers in patients with coronary artery disease - Am J Cardiol. 2006 Sep 15;98(6):743-5 - "Addition of niacin resulted in a 32% increase in large-particle HDL (p <0.001), an 8% decrease in small-particle HDL (p = 0.0032), an 82% increase in large-particle LDL (p = 0.09), and a 12% decrease in small-particle LDL (p = 0.008)"
• Prolonged-Release Nicotinic Acid Combined With a Statin in NAUTILUS - Medscape, 10/19/06 - "The safety and tolerability profiles of prolonged-release nicotinic acid did not differ in patients who were and were not taking a statin. In particular, there was no sign of serious hepatic or muscle toxicity in patients receiving prolonged-release nicotinic acid with a statin. The addition of prolonged-release nicotinic acid to a statin raised levels of HDL cholesterol"
• Comparative Effects on Lipid Levels of Niaspan and Statins - Medscape, 7/28/06 - "Niacin is the best HDL-cholesterol raising drug right now"
• Niacin Extended-Release Tablets Combined With Low/Moderate Dosed Statin Achieves Better Total Lipid Control Versus Higher Dose Statin Monotherapy or Simvastatin and Ezetimibe - Doctor's Guide, 6/22/06 - "patients given Niaspan in combination with a low to moderate dose of Lipitor or Crestor achieved equivalent reduction in LDL-C (51-58%), 1.2 to 1.9-fold greater decreases in triglycerides and 2.5 to 3.5 fold greater increases in HDL-C, than patients who received high-dose Crestor or Zocor/Zetia"
• Aspirin for Preventing Flushing from Niacin - Medscape, 6/13/06 - "the impact of flushing can be minimised by careful dose escalation, administering 'extended-release' NA at bedtime, administering ASA 30 min before 'extended-release' NA and avoiding alcohol or hot drinks near the timeof administration"
• Hypertriglyceridemia - Medscape, 6/1/06 - "ER niacin has been shown to lower the triglyceride level by ~25% and raise the HDL level by almost 30%"
• About 5% of Long-term Niacin Users Evolve Into HDL Hyperresponders - Doctor's Guide, 3/14/06 - "about 5% of patients on long-term therapy become hyperresponders, increasing their HDL levels by 50% or more ... Overall, these patients lost 4% of body weight while on niacin treatment"
• Combination Treatment Shown for First Time to Cause Regression of Atherosclerosis - Doctor's Guide, 11/16/05 - "reversal of atherosclerosis - a primary cause of stroke and heart attacks - can be achieved with a combination of Niaspan (prolonged-release nicotinic acid) and a statin ... ARBITER 2 clearly showed that statins alone are not enough to halt the progression of atherosclerosis even when the LDL-C target is met. However, the addition of Niaspan 1000 mg stopped the progression of atherosclerosis in 12 months ... a further 12 months of treatment with Niaspan and a statin actually achieves regression of atherosclerosis"
• Adding Niacin to Lovastatin Therapy Might Improve Efficacy for Dyslipidemia - Doctor's Guide, 10/5/05 - "Niacin has been shown to be one of the most effective drugs for improving levels of high-density lipoprotein (HDL) cholesterol, or good cholesterol ... Combining the best LDL lowering and best HDL raising drugs makes sense"
• Can Niacin Slow the Development of Atherosclerosis - Medscape, 5/20/05 - "Extended-release niacin slowed the development of atherosclerosis in adults with coronary artery disease, independently from statin therapy"
• The Effects of Niacin on Lipoprotein Subclass Distribution - Medscape, 1/19/05 - "the combination of niacin and a statin may be among the best available treatment options for many patients with complex forms of dyslipidemia ... Niacin effectively modifies all major lipids and lipoproteins with respect to both their quantity and quality. It is the most effective agent currently available for raising low levels of HDL cholesterol"
• Two-Pronged Cholesterol Approach Works - HealthDay, 11/11/04 - "Niacin is the most effective treatment to treat low HDL ... Overall, combining niacin with a statin slowed disease progression 68 percent more than a statin alone. The combination treatment also resulted in a 60 percent reduction in heart attacks, deaths, strokes, and other coronary events"
• Niacin in Diet May Prevent Alzheimer's - WebMD, 7/14/04 - "those who got the least niacin were 70% more likely to develop Alzheimer's disease than those who got higher amounts ... Those at the study's highest niacin level were getting 45 mg per day in diet and supplements"
• Niacin Extended-Release/ Lovastatin Combination Effective in Patients with Multiple Lipid Disorders - Doctor's Guide, 4/23/03 - "Treatment by niacin ER/lovastatin was found to be more effective than each of its components, showing improved levels of low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and triglycerides (TG)" - Note:  Niacin usually increases HDL (the good cholesterol) much more than statins.  From my own experience and from taking to others, it seems like many physician's may ignore low HDL.
• Statins May Cut Alzheimer's Risk - HealthDay, 4/21/03 - "extended-release niacin reduced brain cholesterol levels by 10 percent" - Note: Red yeast rice is a non-prescription statin but you should still check with your physician.  See red yeast rice at Amazon.com.
• Raising HDL-C Levels Slows CAD Progression and Reduces Mortality - Medscape, 4/3/04 - "Results of two studies of high-density lipoprotein cholesterol (HDL-C)-targeted therapies indicate that attacking heart disease by increasing HDL-C levels appears to slow progression of atherosclerosis and reduce mortality ... Although the protective effect of HDL-C is well known, "most researchers ignore this fact," said Henrietta Reicher-Reiss, MD, from Sheba Medical Center in Tel Hashomer, Israel. It is a costly oversight since "about half of heart attack victims have normal [low-density liprotein cholesterol (LDL-C) levels]," ... drugs designed to target HDL-C have a number of adverse effects. Niacin, for example, causes flushing, and fibrates are associated with gastrointestinal side effects. That side-effect profile might be a factor against this approach. Statins, on the other hand, tend to be very well tolerated"
• Vitamin K and niacin good for complexion, experts say - HealthDay, 3/26/03 - "Vitamin K was found to be successful in treating dark circles under the eyes. It's also been found effective for treating bruising on the face following dermatologic procedures such as laser treatment for spider veins ... Niacin shows promise as an over-the-counter ingredient in anti-aging products"
• Alzheimer's Disease and Dementia: Vitamins Can Help Prevent - WebMD, 2/28/03 - "High levels of a substance in the blood called homocysteine tops the list of potentially new risk factors for heart disease, stroke, and now dementia. A new study suggests that high homocysteine levels are linked with mental declines associated with Alzheimer's disease in elderly people ... High homocysteine levels can be treated very easily with vitamins, including folate, niacin, and B-12"
• Statin-Niacin Combination Counters Dyslipidaemic Cardiovascular Risk - Doctor's Guide, 12/20/02 - "Combined statin-niacin is a safe, tolerated therapy that lowers low density lipoprotein cholesterol and raises high density lipoprotein cholesterol ... At niacin doses of at least 1000 (mean 1480) mg/day added to a constant statin regimen in 29 patients, high density lipoprotein cholesterol rose significantly (by 20 percent)"
• Niacin Appears Safe for Treating Patients Who Have Diabetes and High Cholesterol - Doctor's Guide, 11/21/02
• Extended-Release Niacin Safe, Effective in Type 2 Diabetes - Medscape, 7/26/02
• Niacin May Be Effective Therapy For Broad Range Of Diabetes-Associated Dyslipidaemias - Doctor's Guide, 7/25/02 - "After niacin treatment, the patients' LDL peak particle diameter increased from 252 +/- 7 Å to 263 +/- 7, the researchers reported. Their small, dense LDLc particle mass decreased from 27 +/- 11 mg/dL to 15 +/- 4 mg/dL. Total HDLc increased from 39 +/- 7 mg/dL to 51 +/- 11 mg/dL. Their HDL2, as the percentage of total HDLc mass, increased from 29 +/- 8 percent to 45 +/- 10 percent, and their Lp(a) decreased from 43 +/- 17 mg/dL to 25 +/- 10 mg/dL ... Twenty-one percent of the patients were unable to tolerate niacin because of reversible adverse effects. Another 14 percent were unable to adhere to the niacin dosing regimen of three times daily"
• 'Advent' Study Highlights Safety And Efficacy Of Niaspan (Niacin) In Diabetic Patients - Doctor's Guide, 7/22/02
• Niacin Helps Hearts - Nutrition Science News, 11/01
• question regarding your new cholesterol-lowering supplement, Policosanol - Life Extension Magazine, 11/01 - "Studies show that niacin (B3) in doses of 1.5 grams to 3 grams lower triglycerides levels and raise HDL concentrations. Those who tolerated higher doses of niacin (nicotinic acid) showed even more improvement in lipid levels. Some people taking just 1000 mg of flush-free niacin see an elevation in beneficial HDL. Green tea also has been shown to elevate levels of HDL while lowering serum triglyceride levels. In the Journal of Molecular Cell Biochemistry, curcumin has been demonstrated, in vivo, to decrease triglycerides and increase HDL. In a study published in 1989 by the Journal of Associated Physicians-India, 125 patients receiving gugulipid showed a drop of 16.8% in triglycerides, and a 60% increase in HDL cholesterol within three to four weeks. Make sure you are taking at least six Mega EPA fish oil capsules daily, as low dose fish oil may not adequately suppress triglycerides. Finally, there are some lifestyle changes you may wish to consider. If you are overweight, weight loss would be recommended, as it would help to lower triglycerides and raise HDL. Also, try reducing carbohydrates, which can raise triglycerides"
• Laboratory Investigations of Erectile Dysfunction - WebMD - "men with erectile dysfunction frequently have low levels of high-density lipoproteins, the good form of cholesterol." (niacin raises HDL)
• Antioxidant Supplements Lessen Response To Cholesterol Drugs - Doctor's Guide, 8/10/01
• Baycol (Cerivastatin) Not To Be Used In Combination With Gemfibrozil, Says Bayer - Doctor's Guide, 7/25/01 - "Statins are known to cause a rare side effect of muscle breakdown ... In a very small percentage of patients, there is a risk of muscle breakdown resulting in kidney damage, which in rare instances can lead to life-threatening kidney failure ... The risk of muscle breakdown is greater in patients taking gemfibrozil as well as other fibric acid derivatives (a group of cholesterol-lowering drugs), cyclosporine (an immunosuppressant), erythromycin (an antibiotic), azole antifungals, or lipid-lowering doses of niacin (nicotinic acid) together with statins including cerivastatin."
• Niaspan (Niacin Extended Release) Superior To Gemfibrozil in Raising "Good" Cholesterol - Doctor's Guide, 5/15/00
• Integrated Health Care: Applying Best Practices From Two Medical Models - Nutrition Science News, 5/01 - "Many alternative care practitioners utilize a "non-flush" version of niacin, called inositol hexaniacinate, instead of regular niacin. This form of niacin does not have the flushing side effect of regular niacin (which can force patients to discontinue use) and is considered safer than niacin"
• Parkinson's Defense - Nutrition Science News, 5/01
• Niacin Reduces Triglycerides, Increases Good Cholesterol In Diabetics - Doctor's Guide, 3/20/01 - "There had been concern that niacin use in diabetic patients might increase blood sugar levels ... but we didn't see that in our study ... Patients were randomised to receive placebo, 1,000 mg of niacin or 1,500 mg of prescription niacin ... Patients taking the active agent increased high-density lipoprotein (HDL) cholesterol by 20 to 24 percent compared with a 4 percent increase among the placebo patients. At the same time, triglycerides were reduced 15 to 29 percent in the patients on niacin compared with a 5 percent reduction among patients taking placebo"
• Nicostatin (Niacin/Lovastatin) Reduces Cholesterol, Triglyceride Levels - Doctor's Guide, 3/16/00
• At the Counter with Dan Lukaczer, N.D., Niacin Good for Diabetics - Nutrition Science News, 3/01
• Niaspan (Niacin Extended Release Tablets) Safe And Effective For Diabetics - Doctor's Guide, 11/14/00
• Statin Plus Niacin Reduces Heart Attack Risk, Reverses Arterial Build-up - Doctor's Guide, 11/13/00
• Research Reveals Soy, Niacin, and Tea Offer Protection From Heart Attack and Stroke - WebMD, 11/13/00
• Niacin Safe And Effective For Cholesterol Lowering In Diabetics - Doctor's Guide, 9/14/00
• Niacin Is Safe for Diabetics With High Cholesterol, Study Shows - WebMD, 9/12/00
• Niaspan (Niacin Extended Release) Superior To Gemfibrozil in Raising "Good" Cholesterol - Doctor's Guide, 11/15/00
• Nicostatin (Niacin/Lovastatin) Reduces Cholesterol, Triglyceride Levels - Doctor's Guide, 3/16/00
• Niaspan (Niacin Extended-Release) Raises HDL Twice As Much as Gemfibrozil - Doctor's Guide, 3/14/00
• Gemfibrozil-Niacin Combination Greatly Increases Good Cholesterol - Doctor's Guide, 3/10/00
• Niacin for Achy Joints - Nutrition Science News, 11/99 - "niacinamide at 3 g/day reduced overall disease severity by 29 percent, inflammation by 22 percent and use of anti-inflammatory medication by 13 percent."
• Sidestep Heart Disease - Nutrition Science News, 5/99

Abstracts:

• Niacin supplementation impairs exercise performance - Int J Vitam Nutr Res 2021 Oct 26 - "Several pre-workout supplements contain niacin, although the exercise performance effects of niacin are poorly understood. The purpose of the present study was to examine the performance effects of niacin versus caffeine as a pre-workout supplement. Twenty-five untrained males were recruited to complete three identical ramped aerobic cycling exercise trials. Participants were administered caffeine (CA) at 5 mg/kg body weight, 1000 mg niacin (NI), or a methylcelluloce placebo (PL) supplement prior to each trial. NI treatment induced significantly higher respiratory exchange ratio (RER) during exercise compared to the CA treatment, but not the PL treatment (PL=0.87±0.08, NI=0.91±0.08, CA=0.87±0.08; p=0.02). Similarly, exercise time to exhaustion (in minutes) was significantly different between the NI treatment and the CA treatment, but not the PL treatment (PL=27.45±4.47, NI=26.30±4.91, CA=28.76±4.86; p<0.01). Habitual caffeine use (p=0.16), habitual aerobic exercise (p=0.60), and habitual resistance exercise (p=0.10) did not significantly affect RER. Similarly, habitual caffeine use (p=0.72), habitual aerobic exercise (p=0.08), and habitual resistance exercise (p=0.39) did not significantly affect total work performed. The elevated RER and decreased time to exhaustion in the NI treatment suggests limited lipid availability during exercise and impaired exercise performance"
• Melanoma and nonmelanoma skin cancer chemoprevention: A role for nicotinamide? - Photodermatol Photoimmunol Photomed. 2017 Jul 5 - "Nicotinamide (Vitamin B3 ) enhances DNA repair, modulates the inflammatory environment produced by UVR, and reduces UV-induced immunosuppression. As nicotinamide reduces the incidence of actinic keratoses and nonmelanoma skin cancers in high-risk individuals and enhances repair of DNA damage in melanocytes, it is a promising agent for the chemoprevention of melanoma in high-risk populations" - [Nutra USA] - See niacin at Amazon.com.
  • What Is the Difference Between Niacin & Niacinamide? - livestrong.com - "Your body can convert niacin into niacinamide"
• Effect of extended-release niacin on plasma lipoprotein(a) levels: A systematic review and meta-analysis of randomized placebo-controlled trials - Metabolism. 2016 Nov;65(11):1664-1678 - "Meta-analysis suggested a significant reduction of Lp(a) levels following ER niacin treatment (weighted mean difference - WMD: -22.90% ... When the studies were categorized according to the administered dose, there was a comparable effect between the subsets of studies with administered doses of <2000mg/day (WMD: -21.85%, 95% CI: -30.61, -13.10, p<0.001) and ≥2000mg/day (WMD: -23.21%" - Note: By "extended release" I assume they're talking about Niaspan.  I haven't seen any studies on Niaspan and liver damage but it seems like it'd be similar to that of the slow release which has been shown to cause liver damage.  The problem wasn't seen in the immediate release niacin.  See:
  • A comparison of the efficacy and toxic effects of sustained- vs immediate-release niacin in hypercholesterolemic patients - JAMA. 1994 Mar 2;271(9):672-7 - "None of the patients taking IR niacin developed hepatotoxic effects, while 12 (52%) of the 23 patients taking SR niacin did" - See Life Extension Vitamin B3 Niacin 500 Mg 100 capsules.  I take two per day.
• Niacin Suppresses Progression of Atherosclerosis by Inhibiting Vascular Inflammation and Apoptosis of Vascular Smooth Muscle Cells - Med Sci Monit. 2015 Dec 29;21:4081-9 - "Niacin inhibits vascular inflammation and apoptosis of VSMCs via inhibiting the NF-κB signaling and the FAK signaling pathway, respectively, thus protecting ApoE-/- mice against atherosclerosis" - See Life Extension Vitamin B3 Niacin 500 Mg 100 capsules.
• Niacin inhibits fat accumulation, oxidative stress, and inflammatory cytokine IL-8 in cultured hepatocytes: Impact on non-alcoholic fatty liver disease - Metabolism. 2015 May 7 - "These findings suggest that niacin, through inhibiting hepatocyte DGAT2 and NADPH oxidase activity, attenuates hepatic fat accumulation and ROS production respectively. Decreased ROS production, at least in part, may have contributed to the inhibition of pro-inflammatory IL-8 levels. These mechanistic studies may be useful for the clinical development of niacin and niacin-related compounds for the treatment of NAFLD/NASH and its complications" - See niacin at Amazon.com.
• Effect of niacin on lipids and glucose in patients with type 2 diabetes: A meta-analysis of randomized, controlled clinical trials - Clin Nutr. 2014 Sep 28 - "Analysis of the results showed that niacin alone or in combination significantly improved lipid abnormalities in patients with TDM, but requires monitoring of glucose in long term treatment"
• Nicotinamide and neurocognitive function - Nutr Neurosci. 2014 Feb 21 - "A literature review was conducted on the effects of nicotinamide and its derivatives as a preventive and therapeutic agent for disorders of neurocognitive function. Specific conditions examined include age-related cognitive decline, Alzheimer's disease, Parkinson's disease, and ischaemic and traumatic brain injury ... nicotinamide may be beneficial in preserving and enhancing neurocognitive function ... Nicotinamide is non-toxic, inexpensive and widely available, and interventional studies in humans, using supplemental doses of nicotinamide, are now warranted" - See nicotinamide at Amazon.com.  It’s just one more nutrient to add to the arsenal that may have a synergistic effect to delay or help prevent Alzheimer’s or dementia.
  • What Is the Difference Between Niacin & Niacinamide? - LiveStrong.com - "Your body can convert niacin into niacinamide ... Niacin and niacinamide have identical function when used as vitamins ... their pharmacologic properties differ. For example, high doses of niacin can cause skin flushing. Niacinamide, however, does not have the same vasodialating, or blood-vessel widening, effects, that niacin has, so it does not lead to skin flushing" - Note:  You'll find contradictory information on the Internet but niacinamide will not raise HDL and niacin will.
• The effect of pioglitazone and extended-release niacin on HDL-cholesterol in diabetes patients in a real-world setting - Int J Clin Pract. 2013 Nov;67(11):1151-8 - "Patients with type 2 diabetes and hyperlipidemia were included for review if they received the combination of pioglitazone at doses ≥ 15 mg/day and extended-release niacin (Niaspan) at doses ≥ 1000 mg/day for ≥6 months ... a statistically significant increase in HDL-C (+ 25.13%, p < 0.0001) was observed at the conclusion of combination therapy. The HDL-C levels progressively increased with duration of combination treatment, and were not correlated with concomitant statin use. Significant decreases in total cholesterol and triglycerides were detected, and HbA1c decreased 0.84% during combination therapy for all therapies combined"
• Niacin Administration Significantly Reduces Oxidative Stress in Patients with Hypercholesterolemia and Low Levels of High-Density Lipoprotein Cholesterol - Am J Med Sci. 2012 Sep 17 - "Oxidative stress has been implicated in the pathogenesis of cardiovascular disorders, including atherosclerosis. In pharmacological doses, niacin (vitamin B3) was proven to reduce total cholesterol, triglyceride, very-low-density lipoprotein, and low-density lipoprotein levels, and to increase high-density lipoprotein (HDL) levels ... Subjects with lower HDL-C levels exhibited higher oxidative stress compared with subjects with normal HDL-C levels. Niacin treatment in hypercholesterolemic patients caused a significant increase in HDL-C and apolipoprotein A1 levels, and a decrease in triglyceride levels. Niacin also significantly reduced oxidative stress ... These results indicate an additional beneficial effect of niacin beyond its ability to affect the lipid profile"
• Propionyl-L-carnitine, L-arginine and niacin in sexual medicine: a nutraceutical approach for erectile dysfunction - Andrologia. 2011 Oct 4 - "In a group of 54 unselected men (35-75 years), consecutively presenting to our ED clinic and naive to other ED treatments, we carried out a single-blind, one-arm study to evaluate the effects of a 3-month supplementation with propionyl-L-carnitine, L-arginine and niacin on their sexual performance ... Analyses on GAQs revealed that treatment improved erections in 40% of cases, with a partial response occurring in up to 77% of enrolled subjects. These preliminary findings indicate that the favourable cardiovascular effects of nutraceuticals might also reflect on male sexual function with possible implication in the treatment and prevention of ED. This study documents a considerable patients' interest toward nutritional supplementation - as first-line or adjunctive treatment to PDE5 inhibitors - that goes beyond the measurable increment in penile rigidity" - See propionyl-l-carnitine products at Amazon.com, niacin at Amazon.com and L-arginine products at Amazon.com.
• Relation Between High-Density Lipoprotein Cholesterol and Survival to Age 85 Years in Men (from the VA Normative Aging Study) - Am J Cardiol. 2011 Feb 4 - "We categorized initial HDL cholesterol into <40 mg/dl (reference group), 40 to 49 mg/dl, or ≥50 mg/dl ... Treating HDL cholesterol as a continuous predictor, we also determined the HR for each 10-mg/dl increment in HDL cholesterol. Fully adjusted HR (95% confidence interval) for survival to 85 years of age for participants with an initial HDL cholesterol level ≥50 mg/dl compared to the reference was 0.72 (0.53 to 0.98). Each 10-mg/dl increment in HDL cholesterol was associated with a 14% (HR 0.86, 0.78 to 0.96) decrease in risk of mortality before 85 years of age. In conclusion, after adjusting for other factors associated with longevity, higher HDL cholesterol levels were significantly associated with survival to 85 years of age" - See niacin at Amazon.com (niacin increases HDL).
• Niacin results in reduced monocyte adhesion in patients with type 2 diabetes mellitus - Atherosclerosis. 2010 Dec 25 - "Patients with type 2 diabetes have increased expression of cell adhesion molecules (CAMs). CAMs and monocyte adhesion mediate essential processes in atherogenesis ... Niacin 1500mg daily raised HDL-cholesterol from 0.8mmol/l (95% CI: 0.7-0.9) to 0.9mmol/l (95% CI: 0.8-1.1), p=0.10, and significantly reduced PECAM-1 by 24.9% (95% CI: 10.9-39.0; p<0.05), increased adiponectin by 30.5% (95% CI: 14.1-47.0; p<0.05), with monocyte adhesion reduced by 9.2% (95%CI: 0.7-17.7; p<0.05) in endothelial cells treated in basal conditions, and 7.8% (95% CI: 3.1-12.5; p<0.05) after TNF-α stimulation ... Monocytes isolated from patients on niacin had reduced adhesion to endothelial cells. Our findings suggest niacin has broad range of effects apart from lipid-modification, and these could be important in cardiovascular risk reduction"
• Combination of niacin extended-release and simvastatin results in a less atherogenic lipid profile than atorvastatin monotherapy - Vasc Health Risk Manag. 2010 Nov 24;6:1065-75 - "niacin extended-release + simvastatin (NER/S) ... NER/S treatment significantly improved apo A-I levels and the apo B:A-I ratio, significantly lowered the number of atherogenic LDL particles and VLDL and chylomicron particles, and increased the mean size of LDL and VLDL particles, compared with atorvastatin"
• Association between extended-release niacin treatment and glycemic control in patients with type 2 diabetes mellitus: analysis of an administrative-claims database - Metabolism. 2010 Dec 23 - "antihyperglycemic agents (AHAs) ... extended-release niacin (ERN) compared with other lipid-modifying therapy (LMT) ... In the ERN cohort, 82.1% of patients experienced no change in AHA prescriptions between baseline and follow-up compared with 79.4% of patients in the LMT cohort (P = .20); 13% of the ERN cohort and 16% of the LMT cohort (P = .17) experienced a dose increase or the addition of another AHA; and 5% of both cohorts were prescribed fewer AHAs or switched to a lower dose (P = .92). Treatment with ERN (vs other types of LMT) did not significantly increase AHA use, implying that T2DM status did not worsen in this cohort"
• New evidence for nicotinic acid treatment to reduce atherosclerosis - Expert Rev Cardiovasc Ther. 2010 Oct;8(10):1457-1467 - "Emerging evidence from clinical and basic research studies indicates that novel direct antiatherosclerotic properties might mediate nicotinic acid-induced cardiovascular protection. Despite some limitations in its clinical use (mainly due to the incidence of adverse events, such as cutaneous flushing and hepatotoxicity), nicotinic acid should be considered as a very potent therapeutic approach to reduce atherosclerosis. Promising research developments are warranted in the near future" - See niacin at Amazon.com.
• High dietary niacin intake is associated with decreased chromosome translocation frequency in airline pilots - Br J Nutr. 2010 Oct 8:1-9 - "Experimental studies suggest that B vitamins such as niacin, folate, riboflavin, vitamin B6 and vitamin B12 may protect against DNA damage induced by ionising radiation (IR) ... We observed a significant inverse association between translocation frequency and dietary intake of niacin (P = 0.02): adjusted rate ratio for subjects in the highest tertile compared with the lowest tertile was 0.58 (95 % CI 0.40, 0.83). Translocation frequency was not associated with total niacin intake from food and supplements as well as dietary or total intake of folate, riboflavin or vitamin B6 or B12. However, the adjusted rate ratios were significant for subjects with ≥ median compared with < median intake of whole grains (P = 0.03) and red and processed meat (P = 0.01): 0.69 (95 % CI 0.50, 0.96) and 1.56 (95 % CI 1.13, 2.16), respectively. Our data suggest that a high intake of niacin from food or a diet high in whole grains but low in red and processed meat may protect against cumulative DNA damage in IR-exposed persons"
  • Airplane Radiation Exposure Protection - "During a cross country flight from NY to LA you are subjected to more radiation from the plane then you are during a chest X-ray" - Note:.  Think about it, if a pilot were to average two round trips per week (very reasonable), that's 4 chest x-rays per week or 208 chest x-rays per year.
• Once-Daily Extended-Release Niacin Lowers Serum Phosphorus Concentrations in Patients With Metabolic Syndrome Dyslipidemia - Am J Kidney Dis. 2010 Sep 29 - Note:  It doesn't have the abstract, just the title but it's something I didn't know.  Most people get too much phosphorus.
• Effect of niacin therapy on cardiovascular outcomes in patients with coronary artery disease - J Cardiovasc Pharmacol Ther. 2010 Jun;15(2):158-66 - "Compared to placebo group, niacin therapy significantly reduced coronary artery revascularization (RR [relative risk]: 0.307 with 95% CI: 0.150-0.628; P = .001), nonfatal myocardial infarction ([MI]; RR: 0.719; 95% CI: 0.603-0.856; P = .000), stroke, and TIA ([transient ischemic attack] RR: 0.759; 95%CI: 0.613-0.940; P = .012), as well as a possible but nonsignificant decrease in cardiac mortality (RR: 0.883: 95% CI: 0.773-1.008; p= 0.066) ... In a meta-analysis of seven trials of secondary prevention, niacin was associated with a significant reduction in cardiovascular events and possible small but non-significant decreases in coronary and cardiovascular mortality"
• A "Hot" Topic in Dyslipidemia Management--"How to Beat a Flush": Optimizing Niacin Tolerability to Promote Long-term Treatment Adherence and Coronary Disease Prevention - Mayo Clin Proc. 2010 Apr;85(4):365-79 - "Approximately 5% to 20% of patients discontinued treatment because of flushing. Flushing may be minimized by taking niacin with meals (or at bedtime with a low-fat snack), avoiding exacerbating factors (alcohol or hot beverages), and taking 325 mg of aspirin 30 minutes before niacin dosing. The current review advocates an initially slow niacin dose escalation from 0.5 to 1.0 g/d during 8 weeks and then from 1.0 to 2.0 g in a single titration step (if tolerated). Through effective counseling, treatment prophylaxis with aspirin, and careful dose escalation, adherence to niacin treatment can be improved significantly"
• Effect of Niacin Therapy on Cardiovascular Outcomes in Patients With Coronary Artery Disease - J Cardiovasc Pharmacol Ther. 2010 Mar 5 - "Compared to placebo group, niacin therapy significantly reduced coronary artery revascularization (RR [relative risk]: 0.307 with 95% CI: 0.150-0.628; P = .001), nonfatal myocardial infarction ([MI]; RR: 0.719; 95% CI: 0.603-0.856; P = .000), stroke, and TIA ([transient ischemic attack] RR: 0.759; 95%CI: 0.613-0.940; P = .012), as well as a possible but nonsignificant decrease in cardiac mortality (RR: 0.883: 95% CI: 0.773-1.008; p= 0.066). CONCLUSIONS: In a meta-analysis of seven trials of secondary prevention, niacin was associated with a significant reduction in cardiovascular events and possible small but non-significant decreases in coronary and cardiovascular mortality"
• Endothelial-Vasoprotective Effects of High-Density Lipoprotein Are Impaired in Patients With Type 2 Diabetes Mellitus but Are Improved After Extended-Release Niacin Therapy - Circulation. 2009 Dec 21 - "Patients with diabetes were randomized to a 3-month therapy with ER niacin (1500 mg/d) or placebo ... HDL from healthy subjects stimulated endothelial nitric oxide production, reduced endothelial oxidant stress, and improved endothelium-dependent vasodilation and early endothelial progenitor cell-mediated endothelial repair. In contrast, these beneficial endothelial effects of HDL were not observed in HDL from diabetic patients, which suggests markedly impaired endothelial-protective properties of HDL. ER niacin therapy improved the capacity of HDL to stimulate endothelial nitric oxide, to reduce superoxide production, and to promote endothelial progenitor cell-mediated endothelial repair. Further measurements suggested increased lipid oxidation of HDL in diabetic patients, and a reduction after ER niacin therapy ... HDL from patients with type 2 diabetes mellitus and metabolic syndrome has substantially impaired endothelial-protective effects compared with HDL from healthy subjects. ER niacin therapy not only increases HDL plasma levels but markedly improves endothelial-protective functions of HDL in these patients, which is potentially more important" - See niacin at Amazon.com.
• Extended-Release Niacin or Ezetimibe and Carotid Intima-Media Thickness - N Engl J Med. 2009 Nov 15 - "This comparative-effectiveness trial shows that the use of extended-release niacin causes a significant regression of carotid intima-media thickness when combined with a statin and that niacin is superior to ezetimibe"
• Niacin and fibrate use among patients with high triglycerides and low high-density lipoprotein cholesterol - Curr Med Res Opin. 2009 May 8 - "among patients with 4 risk factors, <20% of patients with low HDL/high TG received niacin and/or a fibrate post-index date ... Our results indicate that in actual clinical practice, niacin and fibrates are underutilized in the treatment of low HDL and high TG" - See niacin at Amazon.com.
• Leukocyte telomere length is associated with HDL cholesterol levels: The Bogalusa heart study - Atherosclerosis. 2009 Jan 24 - "Diminished levels of HDL-C are associated with an increased risk for atherosclerosis. Shortened leukocyte telomere length (LTL) also entails an increased atherosclerotic risk ... Multivariate regression analyses showed that LTL was positively associated with HDL-C in childhood (regression coefficient (bp per mg/dL) beta=3.1, p=0.024), adulthood (beta=4.4, p=0.058) and AUC from childhood to adulthood ... A slower rate of LTL shortening per year was associated with higher HDL-C AUC in the total sample (p=0.033), adjusting for baseline LTL ... As HDL-C exerts anti-oxidant and anti-inflammatory effects and LTL registers the accruing burden of oxidative stress and inflammation, the association between HDL-C and LTL might be explained by the lifelong status of oxidative stress and inflammation" - Note:  Telomere length is associated with longer lifespan.  Niacin increases HDL.  See niacin at Amazon.com.
• A comparison of the pharmacokinetics of two different formulations of extended-release niacin - Curr Med Res Opin. 2009 Jan;25(1):15-22
• Comparison of the Safety and Efficacy of a Combination Tablet of Niacin Extended Release and Simvastatin vs Simvastatin Monotherapy in Patients With Increased Non-HDL Cholesterol (from the SEACOAST I Study) - Am J Cardiol. 2008 May 15;101(10):1428-36 - "The efficacy and safety of 2 regimens of a combination of a proprietary niacin extended release plus simvastatin (NER/S; 1,000/20 and 2,000/20 mg/day) were compared with simvastatin monotherapy (20 mg/day) for 24 weeks ... The safety of NER/S was consistent with the safety profile of each individual component. In conclusion, this study showed that NER/S provided additional clinically relevant improvements in multiple lipid parameters and was safe and well tolerated"
• Effects of niacin on glucose control in patients with dyslipidemia - Mayo Clin Proc. 2008 Apr;83(4):470-8 - "the effects of niacin (</=2.5 g/d), alone or in combination with statins, on fasting glucose (an increase of 4%-5%) and hemoglobin A1c levels (an increase of </=0.3%) are modest, transient or reversible, and typically amenable to adjustments in oral hypoglycemic regimens without discontinuing niacin. Niacin therapy was infrequently associated with incident diabetes or the need for new insulin prescriptions. Studies showed important clinical benefits of niacin or niacin-statin regimens despite modest effects on glucose control. On a population basis, significant reductions in incidences of cardiovascular events and the degree of atherosclerotic progression associated with long-term niacin (or niacin-statin) therapy in patients with diabetic dyslipidemia outweigh the typically mild effects of this therapy on glycemic regulation"
• The flavonoid luteolin inhibits niacin-induced flush - Br J Pharmacol. 2008 Jan 28 - "Sustained release niacin effectively lowers serum cholesterol, LDL and triglycerides, while raising HDL. However, 75% of patients experience cutaneous warmth and itching known as flush, leading to discontinuation. Acetylsalicylic acid (aspirin) reduces this flush only by about 30% ... Quercetin and luteolin (4.3 mg per rat; 1000 mg per human), administered i.p. 45 min prior to niacin, inhibited the niacin effect by 96 and 88%, respectively. Aspirin (1.22 mg per rat; 325 mg per human) inhibited the niacin effect by only 30%. Niacin almost doubled plasma PGD(2) and 5-HT, but aspirin reduced only PGD(2) by 86%. In contrast, luteolin inhibited both plasma PGD(2) and 5-HT levels by 100 and 67%, respectively" - See quercetin at Amazon.com.
• Increased total and high-molecular weight adiponectin after extended-release niacin - Metabolism. 2008 Mar;57(3):404-9 - "at least part of the cardioprotective benefits of niacin may be attributed to a shift in the HMW/LMW adiponectin ratio in obese men with the metabolic syndrome"
• Preferential increase in high-molecular weight adiponectin after niacin - Atherosclerosis. 2007 Nov 7 - "treatment with niacin raises adiponectin between 52% and 95% in patients with the metabolic syndrome"
  • Adiponectin definition - medterms.com - "High blood levels of adiponectin are associated with a reduced risk of heart attack. Low levels of adiponectin are found in people who are obese (and who are at increased risk of a heart attack)."
• The effects of extended-release niacin on carotid intimal media thickness, endothelial function and inflammatory markers in patients with the metabolic syndrome - Int J Clin Pract. 2007 Nov;61(11):1942-8 - "After 52 weeks of treatment, there was a change of carotid IMT of +0.009 +/- 0.003 mm in the placebo group and -0.005 +/- 0.002 mm in the niacin group (p = 0.021 between groups). Endothelial function improved by 22% in the group treated with niacin (p < 0.001), whereas no significant changes were seen in the placebo group. High sensitivity C-reactive protein decreased by 20% in the group treated with niacin for 52 weeks (p = 0.013). Niacin increased HDL-C (p < 0.001) and decreased low-density lipoprotein cholesterol and triglycerides (p < 0.001) significantly, and there were no adverse effects on fasting glucose levels after 52 weeks of treatment" - See niacin at Amazon.com or niacin at Amazon.com.
• Safety considerations with niacin therapy - Am J Cardiol. 2007 Mar 19;99(6A):S22-31 - "Overall, the perception of niacin side effects is often greater than the reality. As a result, a valuable medication for cardiovascular risk is underused"
• Aspirin reduces cutaneous flushing after administration of an optimized extended-release niacin formulation - Int J Clin Pharmacol Ther. 2007 Feb;45(2):78-88 - "Aspirin significantly reduced the incidence, intensity and duration of flushing associated with reformulated niacin ER"
• Effects of extended-release niacin on lipoprotein particle size, distribution, and inflammatory markers in patients with coronary artery disease - Am J Cardiol. 2006 Sep 15;98(6):743-5 - "Addition of niacin resulted in a 32% increase in large-particle HDL (p <0.001), an 8% decrease in small-particle HDL (p = 0.0032), an 82% increase in large-particle LDL (p = 0.09), and a 12% decrease in small-particle LDL (p = 0.008)"
• Benefits of Niacin in Patients With Versus Without the Metabolic Syndrome and Healed Myocardial Infarction (from the Coronary Drug Project) - Am J Cardiol. 2006 Feb 15;97(4):477-9 - "Niacin decreased the occurrence of 6-year MI and 15-year total mortality similarly among patients with or without the MS. For example, in the total population, 15-year total mortality rates were 60% and 64% (hazard ratio 0.86) in patients with the MS treated with niacin and placebo, respectively, and 50% and 57% (hazard ratio 0.86) in those without the MS ... these results support the use of niacin in postinfarction patients with and without the MS"
• Effect of niacin on lipid and lipoprotein levels and glycemic control in patients with diabetes and peripheral arterial disease: the ADMIT study: A randomized trial. Arterial Disease Multiple Intervention Trial - JAMA. 2000 Sep 13;284(10):1263-70 - "After an active run-in period, participants were randomly assigned to receive niacin (crystalline nicotinic acid), 3000 mg/d or maximum tolerated dosage (n = 64 with diabetes; n = 173 without diabetes), or placebo ... Niacin use significantly increased HDL-C by 29% and 29% and decreased triglycerides by 23% and 28% and low-density lipoprotein cholesterol (LDL-C) by 8% and 9% ... Glucose levels were modestly increased by niacin (8.7 and 6.3 mg/dL [0.4 and 0.3 mmol/L]; P =.04 and P<.001) in participants with and without diabetes, respectively ... Our study suggests that lipid-modifying dosages of niacin can be safely used in patients with diabetes"
• New Perspectives on the Use of Niacin in the Treatment of Lipid Disorders - Arch Intern Med, 4/12/04
• A randomized trial of the effects of atorvastatin and niacin in patients with combined hyperlipidemia or isolated hypertriglyceridemia - Am J Med. 1998 Feb;104(2):137-43
• Prolonged treatment with slow release nicotinic acid in patients with type II hyperlipidemia - Pol Arch Med Wewn. 1997 Nov;98(11):391-9
• Dose-response characteristics of cholesterol-lowering drug therapies: implications for treatment - Ann Intern Med. 1996 Dec 15;125(12):990-1000
• The effect of long-term Enduracin monotherapy on the clinical and biochemical status of patients with ischemic heart disease - Ter Arkh. 1997;69(9):41-5
• A comparison of the efficacy and toxic effects of sustained- vs immediate-release niacin in hypercholesterolemic patients - JAMA. 1994 Mar 2;271(9):672-7 - "None of the patients taking IR niacin developed hepatotoxic effects, while 12 (52%) of the 23 patients taking SR niacin did. CONCLUSION--The SR form of niacin is hepatotoxic and should be restricted from use. The IR niacin is preferred for the management of hypercholesterolemia but can also cause significant adverse effects and should be given only to patients who can be carefully monitored by experienced health professionals."
• Fifteen year mortality in Coronary Drug Project patients: long-term benefit with niacin - J Am Coll Cardiol. 1986 Dec;8(6):1245-55 - "Mortality in the niacin group was 11% lower than in the placebo group"