The safest, most effective, and cheapest treatment for highcholesterol is a vitamin that costs 7 cents per pill, according to a new reportfrom Orthomolecular Medicine News Service (OMNS), a nonprofit research group inWichita, Kansas.
Vitamin B3—also called niacin or nicotinic acid—has beensafely used for 60 years to control cholesterol, with some 42,000 scientificpapers in PubMed describing its benefits and effects.
“Unlike statin drugs, which mainly reduce LDL cholesterol,niacin is a very safe, effective treatment for all lipid issues, improving levels of both good and bad cholesteroland triglycerides, ” says BradleyBale, MD, medical director of the Heart Health Program for Grace Clinic inLubbock, Texas.
One landmark study published in Journal of the AmericanCollege of Cardiology found that at therapeutic doses, niacin boosted HDLby up to 35 percent and cut triglycerides by as much as 50 percent.
Most remarkably, when the researchers tracked the 8,431participants—all of whom had suffered heart attacks prior to enrolling in thestudy—for 15 years, those on niacin had a 26 percent lower risk for both heartattacks and strokes, even after treatment was discontinued, compared to those takinga placebo.
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Despite some 42,000 scientific papers in PubMed describing niacin’seffectiveness and medical uses, it’s remained the ugly duckling of heartmedicines, for a variety of reasons.
“The simple answeris to follow the money,” contends OMNS. “Cholesterol-controlling drugs [such asstatins] are cash cows for the trillion-dollar-per-year pharmaceuticalindustry,” while there’s no marketing push to persuade medical providers torecommend a cheap, OTC remedy like niacin.
In his practice,Dr. Bale typically recommends niacin for the following patients, if medicallyappropriate:
  • Peoplewith high cholesterol who can’t tolerate statin drugs. About 20 percent ofstatin users quit taking their medication due to side effects.
  • Patientswith complex lipid issues, such as low levels of heart-protective HDL (good)cholesterol and high triglycerides (a type of blood fat).
  • Peoplewith inherited cholesterol disorders, such as elevated levels of lipoprotein(a), a type of cholesterol that triples heart attack risk and does not respondto statins. Taking niacin can reduce lipoprotein (a) levels by up to 40percent, according to the European Atherosclerosis Society.
  • Patientswhose cholesterol problems aren’t responding to statins. Several studies showthat statins plus niacin is more effective than statins alone.
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Side Effects of Niacin

In doses typicallyused to control cholesterol the vitamin can have an annoying side effect knownas “the niacin flush,” a temporary and sometimes itchy or tingling redness ofthe skin that lasts about 30 to 60 minutes.
“Doctors know thatif they advise niacin, they get calls from patients complaining about flushing,particularly at first,” says Dr. Bale. “However, this problem is harmless andcan often be avoided by starting with a low dose that’s gradually increased.”Patients who experience flushing initially will typically find that the problemdisappears or greatly diminishes over time.
While “non-flush” andextended-release forms of niacin are available, they appear to be lesseffective or may even have dangerous side effects, Dr. Bale adds. “There aretwo pathways through which the body can metabolize niacin, and the one thatdoesn’t cause flushing is more likely to harm the liver.”
Dr. Bale advisesavoiding non-flush or extended-release formulations. In addition, niacin shouldonly be used under the supervision of a healthcare provider, after a fulldiscussion of the potential risks and benefits.
Like statins,niacin can cause muscle problems in some patients. It can also spark flare-upsin people with gout, and may contribute to GI bleeding in patients with ulcers,cautions Dr. Bale. “Any cholesterol treatment can cause side effects, butcompared to statins, niacin is relatively safe.”
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A Controversial NiacinStudy

In March, results of a highly publicized study of Tredaptive, an experimental drug containing extended-releaseniacin plus an anti-flushing drug called laropiprant, were interpreted by themedia as showing that niacin may have dangerous side effects.
In the study, 25,673patients who were already being treated with statins were randomly divided into2 groups. One group took a statin drug plus Tredaptive and the other groupreceived the same dose of statin along with a placebo.
Patients takingTreadaptive had higher rates of bleeding (2.5 percent vs. 1.9 percent) andinfections (8 percent vs. 6.6 percent), as well as higher rates of new onsetdiabetes (9.1 percent vs. 7.3 percent). Nor did the patients on theexperimental drug have lower rates of heart attack or stroke.
The study washalted prematurely, after four years, due to these problems and the maker ofthe experimental drug, Merck, announced that it wouldn’t be seeking FDAapproval.
While media reportsblamed these problems on niacin, Dr. Bale and other experts point out theseadverse effects haven’t been seen in numerous previous studies of the vitaminon its own, so the anti-flushing drug is the likely culprit.
“Niacin is beingthrown under the bus when it’s an inexpensive, effective treatment that’s beenused very safely for decades,” says Dr. Bale. “What this study is telling us isthat this particular no-flush combination drug doesn’t work and can have significant sideeffects.”