Niacin (vitamin B3) offers good news to Americans, for whom
cardiovascular disease is the leading cause of death and who continue to live at
high risk because of high cholesterol levels. Research supports the use of
niacin as a safe and possibly more effective alternative to conventional
cholesterol-lowering medications. In addition, niacin is a very affordable
Cholesterol is an important part of a healthy body. The body uses it to make
vitamin D (required for the normal growth of bones and teeth) and various
hormones, including the sex hormones. There are two kinds of cholesterol in your
body: low-density lipoprotein, or LDL cholesterol, and high-density lipoprotein,
or HDL cholesterol. These two types are sometimes referred to as the
"bad cholesterol" and the "good cholesterol," and here's why: high levels of LDL
cholesterol in the blood contribute to the development of atherosclerosis, or
hardening of the arteries, which kills approximately 1 million Americans each
year. High levels of HDL cholesterol, on the other hand, appear to lower a
person's risk for heart disease.
In clinical studies, niacin has been shown to both lower LDL cholesterol
levels and increase HDL cholesterol levels. One trial compared the effectiveness
of niacin to that of lovastatin (trade names Mevacor or Mevinolin), a commonly
prescribed LDL cholesterol-lowering drug. In this study, 136 patients with high
cholesterol received either lovastatin or niacin daily. After 26 weeks, LDL
cholesterol levels were reduced more in the lovastatin group (32 versus 23
percent). However, HDL cholesterol levels were increased more in the niacin
group (33 versus 7 percent). This is noteworthy because the risk for heart
disease is reduced more by raising HDL cholesterol levels than by lowering LDL
However, there is a side effect from niacin use that discourages some people
from taking it. High doses of niacin can cause
flushing—a sudden tingling, itching, and reddening of
the face, neck, and chest. This side effect is uncomfortable but not dangerous.
Slow-release forms of niacin are available and may reduce this effect; however,
these may also be harmful to your liver. One possible solution is to take niacin
supplements that are in the form of inositol hexanicotinate (IHN). This form of
niacin is metabolized slowly by your body, reducing the possibility of flushing.
IHN has been used in Great Britain for years to lower cholesterol levels.
To get niacin's heart benefits you will need to supplement your diet with 1.5
to 4.0 grams daily, divided into two or three doses. While there are a number of
dietary sources rich in niacin (such as foods high in protein, like meat, eggs,
and peanuts), none of these contain more than about 20 mg of niacin per serving.
As always, it is very important to work with your doctor to determine which
cholesterol-lowering treatments are right for you. Some dietary supplements
should not be taken if you have certain medical conditions or are taking
particular prescription medications.
American Heart Association. Leading causes of death: 1996 Cardiovascular
Disease. Accessed at http://www.americanheart.org/statistics/biostats/biolc.htm
on March 23, 2000.
Illingworth DR, Stein EA, Mitchel YB, et al. Comparative effects of
lovastatin and niacin in primary hypercholesterolemia. A prospective trial.
Arch Intern Med. 1994;154(14):1586-1595.
O'Connor PJ, Rush WA, Trence DL. Relative effectiveness of niacin and
lovastatin for treatment of dyslipidemias in a health maintenance organization.
J Fam Pract. 1997;44(5):462-467.
McKenney JM, Proctor JD, Harms S, Chinchili VM. A comparison of the efficacy
and toxic effects of sustained- vs immediate-release niacin in
hypercholesterolemic patients. JAMA. 1994;271(9):672-677.
Sempos CT, Cleeman JI, Carroll MD, et al. Prevalence of high blood
cholesterol among US adults. An update based on guidelines from the second
report of the National Cholesterol Education Program Adult Treatment Panel.
Welsh AL, Ede M. Inositol hexanicontinate for improved nicotinic acid
therapy. Preliminary report. Int Record Med.
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