Niacin and heart disease prevention: Engraving its tombstone is a mistake.

Abstract in brief

• Niacin (nicotinic acid) has historically been used for over 40 years to prevent coronary heart disease, showing benefits like reducing clinical events and improving lesions, including a 6% absolute reduction in mortality, but recent large trials in 2011 and 2014 found no additional benefit when added to statin therapy.
• Differences in trial design, patient populations, niacin formulations, dosages, and timing (mealtime vs. bedtime dosing) may explain why earlier studies showed benefits while newer trials did not, with the most benefit seen in patients with high LDL cholesterol and triglycerides and low HDL cholesterol.
• Due to these mixed results, some experts suggest stopping the use of niacin in statin-treated patients and the US FDA to halt marketing of combined statin-niacin medications, emphasizing the importance of proper formulation, dose, and timing to potentially achieve lipid improvements and cardiovascular benefits.]