Harvard Health Letter

Niacin + a statin does not add up to benefit

In 2011, federal health officials ended an important government-funded clinical trial designed to test whether taking niacin in addition to a cholesterol-lowering statin might do more to lower heart attack and stroke risk than just taking a statin alone. Interim data indicated that the niacin had no benefit and may have been associated with a small, unexplained increase in stroke risk.

Full results of the AIM-HIGH trial, as it was called, were published several months later in The New England Journal of Medicine. Experts continue to fight over the AIM-HIGH results in that ferocious way that experts often do. Some say the results are strong evidence for not adding niacin to statin therapy. Others are adamant that AIM-HIGH missed the mark because of the way it was designed and that it will take the results of a different trial, dubbed THRIVE, to determine if niacin-statin combinations have cardiovascular benefits.

Another name for niacin is vitamin B3, and we need small amounts of it — about 15 milligrams a day — to prevent a nutritional deficiency disease called pellagra (a major public health problem in the American South in the early 20th century). But niacin in large amounts — about 2,000 mg a day — was also found to have an effect on cholesterol levels, tamping down "bad" LDL cholesterol some and increasing "good" HDL by quite a lot. It also modestly reduces elevated triglyceride levels, which are associated with heart disease.

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