Cholesterol, High Cholesterol

Increasing HDL cholesterol with niacin:

Niacin is one of the strongest acting agents known to increase high-density lipoprotein (HDL) and is the recommended treatment to lower lipoprotein (a) which helps reduce the risk of heart disease (58,59), and result in less cardiac events (62). Niacin also lowers LDL cholesterol a small amount (60).

Immediate release niacin vs. sustained release niacin:

A study compared both immediate release and sustained release niacin therapy starting at 500 mg with a dose escalation every 6 weeks up to 3000 mg yielded the following results (61):

• Immediate release niacin increased HDL cholesterol more than the sustained release form.
• Sustained release niacin lowered LDL better than immediate release niacin at a dose of 1500 mg per day.
• Triglycerides were decreased to similar levels with both forms of niacin.
• According to the author, sustained release niacin was unsafe since hepatotoxicity occurred in over 50% of this group, but did not occur in any subjects taking the immediate release form.

Expected HDL improvement with niacin:

Use of niacin, vitamin B3, in patients with cardiovascular disease (n=55) was associated with a 31% increase in high-density lipoprotein (HDL), at a dose of 1g low-dose long-acting niacin daily. Use of niacin showed no significant change in total cholesterol or triglyceride levels. Individuals not taking niacin (n=17) saw no change in lipid levels. 40% of subjects were reported to stop the drug due to side effects. (58)