Current Atherosclerosis Reports

, Volume 14, Issue 1, pp 49–59 | Cite as

Niacin: The Evidence, Clinical Use, and Future Directions

  • Todd C. VillinesEmail author
  • Andrew S. Kim
  • Rosco S. Gore
  • Allen J. Taylor
Nonstatin Drugs (W Borden, Section Editor)


The use of FDA-approved niacin (nicotinic acid or vitamin B3) formulations at therapeutic doses, alone or in combination with statins or other lipid therapies, is safe, improves multiple lipid parameters, and reduces atherosclerosis progression. Niacin is unique as the most potent available lipid therapy to increase high-density lipoprotein (HDL) cholesterol and it significantly reduces lipoprotein(a). Through its action on the GPR109A receptor, niacin may also exert beneficial pleiotropic effects independent of changes in lipid levels, such as improving endothelial function and attenuating vascular inflammation. Studies evaluating the impact of niacin in statin-naïve patients on cardiovascular outcomes, or alone and in combination with statins or other lipid therapies on atherosclerosis progression, have been universally favorable. However, the widespread use of niacin to treat residual lipid abnormalities such as low HDL cholesterol, when used in combination with statins among patients achieving very low (<75 mg/dL) low-density lipoprotein cholesterol levels, is currently not supported by clinical outcome trials.


Niacin Nicotinic acid Lipids HDL cholesterol Lipoprotein (a) Apolipoprotein B Statin Atherosclerosis Atherosclerosis imaging Combination lipid therapy Laropiprant 



T.C. Villines has received honorarium from Boehringer-Ingelheim; A.S. Kim: none; R.S. Gore: none; A.J. Taylor has received honorarium from Abbott.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media, LLC (outside the USA) 2011

Authors and Affiliations

  • Todd C. Villines
    • 1
    • 4
    Email author
  • Andrew S. Kim
    • 1
  • Rosco S. Gore
    • 1
  • Allen J. Taylor
    • 2
    • 3
  1. 1.Cardiology Service, Department of MedicineWalter Reed National Military Medical CenterBethesdaUSA
  2. 2.Washington Hospital CenterWashingtonUSA
  3. 3.Georgetown University School of MedicineWashingtonUSA
  4. 4.Uniformed Services University School of MedicineBethesdaUSA

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