Niacin Therapy Risks and Considerations

Cardiovascular and Metabolic Risks

The American Heart Association recommends caution when using niacin in patients with unstable angina or in the acute phase of myocardial infarction, as recent major trials (AIM-HIGH and HPS2-THRIVE) showed no cardiovascular benefit when niacin was added to statin therapy in patients with pre-existing CVD and well-controlled LDL-C 2, 3, 4
The American Diabetes Association notes that niacin treatment can increase fasting blood glucose and worsen glucose intolerance in a dose-related manner, with an absolute excess of 1.3 percentage points for new-onset diabetes in the HPS2-THRIVE trial 1
The American College of Cardiology recommends monitoring glucose levels closely in diabetic patients, as niacin can increase the risk of myopathy and rhabdomyolysis, particularly when combined with statins 2, 3, 4

The National Institute of Diabetes and Digestive and Kidney Diseases reports that diarrhea occurs in >5% of patients taking niacin, and may require fluid replacement with oral rehydration solutions 7
The American Academy of Dermatology notes that flushing is the most common adverse reaction to niacin, occurring in the majority of patients, typically within 30 minutes of ingestion and abating after 60 minutes 8
The American Heart Association recommends premedication with aspirin 325 mg taken 30 minutes before niacin to alleviate flushing 9